Active NPI
Joan Marie Odom, MD
- Child & Adolescent Psychiatry Physician
- Irvine, CA
National Provider Identifier
1740216803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 77133
- Practice address
- 8 Chamomile
Irvine, CA 92604 - Phone
- (818) 720-2116
- NPI assigned
- Jun 23, 2006
- Last updated
- Nov 10, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Forensic Psychiatry Physician | 2084F0202X | 77133 | CA | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 77133 | CA | Primary |
Addresses
Primary practice location
8 Chamomile
Irvine, CA 92604
Mailing address
1600 9TH St
Room 205 Mailstop 2 3
Sacramento, CA 95814-6414
Phone (916) 654-2431
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 77133 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of California - Department of Developmental Services | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Lanterman Community Clinic
- Federally Qualified Health Center (FQHC)
- Pomona, CA
- NPI 1093085565
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478736000000",
"number": "1740216803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 9TH ST",
"address_2": "ROOM 205 MAILSTOP 2 3",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958146414",
"telephone_number": "916-654-2431",
"fax_number": "916-654-3186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8 CHAMOMILE",
"city": "IRVINE",
"state": "CA",
"postal_code": "92604",
"telephone_number": "818-720-2116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODOM",
"first_name": "JOAN",
"middle_name": "MARIE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-23",
"last_updated": "2016-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "2084F0202X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Forensic Psychiatry",
"state": "CA",
"license": "77133",
"primary": false
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "CA",
"license": "77133",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irvine, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.