NPIMap

Organization Active NPI

Regenerative Wound Solutions PC

  • Wound Care Registered Nurse
  • Bronx, NY
National Provider Identifier
1730928235
Registry record updated May 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Wound Care Registered NurseTaxonomy code 163WW0000X
Legal business name
REGENERATIVE WOUND SOLUTIONS PC
Practice address
4770 White Plains Rd
Bronx, NY 10470-1136
Phone
(718) 534-0689
NPI assigned
May 23, 2024
Last updated
May 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2024

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

Authorized official

Name
Carroll OdemNPI 1144224957
Title
Owner
Phone
(718) 534-0689

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Wound Care Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WW0000X Primary

Addresses

Primary practice location

4770 White Plains Rd
Bronx, NY 10470-1136

Mailing address

4770 White Plains Rd
Bronx, NY 10470-1136

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240711003920 GA Part B Supplier - Clinic/Group Practice 2668917865 Receives reassigned benefits from 12 practitioners
Practice locations: Atlanta, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1716422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716422400000",
    "number": "1730928235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4770 WHITE PLAINS RD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104701136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4770 WHITE PLAINS RD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104701136",
            "telephone_number": "718-534-0689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENERATIVE WOUND SOLUTIONS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-23",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A",
        "authorized_official_last_name": "ODEM",
        "authorized_official_first_name": "CARROLL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-534-0689"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.