Active NPI
Mark P O'Dell, LCSW
- Clinical Social Worker
- Monroe, NC
National Provider Identifier
1720260102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 1190 W Roosevelt Blvd
Monroe, NC 28110-2818 - Phone
- (704) 296-6200
- NPI assigned
- Nov 28, 2007
- Last updated
- Jan 3, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | C005296 | NC | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
1190 W Roosevelt Blvd
Monroe, NC 28110-2818
Mailing address
1305 S Cannon Blvd
Kannapolis, NC 28083-6232
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6106809 | Medicaid | NC | |
| 147NF | Other | NC | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199318400000",
"number": "1720260102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1305 S CANNON BLVD",
"city": "KANNAPOLIS",
"state": "NC",
"postal_code": "280836232"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1190 W ROOSEVELT BLVD",
"city": "MONROE",
"state": "NC",
"postal_code": "281102818",
"telephone_number": "704-296-6200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'DELL",
"first_name": "MARK",
"middle_name": "P",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-11-28",
"last_updated": "2008-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NC",
"license": "C005296",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6106809",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "147NF",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Monroe, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.