Odette E Davis, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

004779 Issued in NY

Practice address

MMC - Dept. of Medicine
111 East 210TH Street
Bronx, NY 10467

Phone

(718) 920-2961

NPI assigned

Feb 8, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Montefiore Medical Center

  • Anesthesiology Physician
  • Bronx, NY
  • NPI 1063525152
  Medicare reassignment NPD (past)
• Medalliance Medical Health Services Inc

  • Clinic/Center
  • Bronx, NY
  • NPI 1558356741
  Medicare reassignment
• Montefiore Medical Center

  • Community/Retail Pharmacy
  • Bronx, NY
  • NPI 1194183715
  NPD
• Montefiore Medical Center

  • Family Medicine Physician
  • New York, NY
  • NPI 1760288278
  NPD
• Jackson Heights Wellness Chiro P.C.

  • Clinic/Center
  • Jackson Heights, NY
  • NPI 1134984065
  NPD (past)
• Montefiore Mount Vernon Hospital

  • General Acute Care Hospital
  • Mount Vernon, NY
  • NPI 1013345065
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730229618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 AMSTERDAM AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100277454",
            "telephone_number": "718-920-2961",
            "fax_number": "718-920-2058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MMC - DEPT. OF MEDICINE",
            "address_2": "111 EAST 210TH STREET",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10467",
            "telephone_number": "718-920-2961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "ODETTE",
        "middle_name": "E",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "004779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Davis, DMD
• Michele Davis
• Natalie Fischer Davis, MD
• Nichola J Davis, MD
• Nikki Giovanni Davis, LPN
• Patricia Davis, NURSE PRACTITIONER
• Raquel Elizabeth Davis, MD
• Shalayla Aranda Davis
• Shana Alexis Davis
• Sharif Davis

• Physician Assistant in Bronx, NY
• Providers in Bronx, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.