NPIMap

Individual provider Active NPI

Carl Irwin Odom, MD

  • Diagnostic Radiology Physician
  • Boise, ID
National Provider Identifier
1740523513
Registry record updated Sep 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
T0301 Issued in TX
Practice address
620 W Hays St
Boise, ID 83702-5511
Phone
(208) 381-2094
Fax
(208) 381-1791
NPI assigned
Mar 31, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 12, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X T0301 TX Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

620 W Hays St
Boise, ID 83702-5511

Mailing address

12554 Riata Vista Cir
Austin, TX 78727-6431
Phone (512) 795-5100

Other identifiers 1

IdentifierTypeStateIssuer
371653203MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210526000224 TX Practitioner - Diagnostic Radiology 8628216769 Reassigns benefits to 2 organizations
I20231027001797 ID Practitioner - Diagnostic RadiologyPractitioner - Nuclear Medicine 8628216769 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Nuclear Medicine
Education
University of Alabama School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Weiser Valley Hospital DistrictGroup PAC ID 5294704276, 60 clinicians
Boise Radiology Group PLLCGroup PAC ID 9638153257, 64 clinicians

Practice addresses (Care Compare)

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 549-0370

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.94 of 100Reported as group
Quality
92.87
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
T0301TXMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Metrohealth System Current Accepting new patients
Austin Radiological Association CurrentSince Jul 1, 2021 Accepting new patients
Singleton Associates PA Diagnostic Radiology CurrentSince Jul 1, 2021 Accepting new patients
Weiser Valley Hospital District Current Accepting new patients
Boise Radiology Group PLLC Diagnostic Radiology CurrentSince Oct 1, 2023 Accepting new patients
North Canyon Medical Center, Inc. CurrentSince Oct 25, 2024 Accepting new patients
Weiser Valley Hospital District Diagnostic Radiology CurrentSince Oct 23, 2023 Accepting new patients
Singleton Associates PA Diagnostic Radiology CurrentSince Jul 1, 2021 Accepting new patients

Locations

620 W Hays St
Boise, ID 83702
Phone (208) 297-6167

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

1000 E Park Blvd
Boise, ID 83712
Phone (208) 381-4100

645 E 5th St
Weiser, ID 83672
Phone (208) 549-0370

6818 Austin Center Blvd
Ste 101
Austin, TX 78731
Phone (512) 794-8505

12554 Riata Vista Cir
Austin, TX 78727
Phone (512) 519-3462

901 W 38th St
Ste 100
Austin, TX 78705
Phone (512) 519-3462

1201 W 38th St
Austin, TX 78705
Phone (512) 324-1058

1401 Medical Pkwy
Cedar Park, TX 78613
Phone (512) 528-7000

2000 Scenic Dr
Georgetown, TX 78626
Phone (512) 863-2117

1110 N Sarah Dewitt Dr
Gonzales, TX 78629
Phone (830) 672-3845

6720 Bertner Ave
#270
Houston, TX 77030
Phone (832) 355-4092

6720 Bertner Ave
#2270
Houston, TX 77030
Phone (832) 355-4092

Interoperability endpoints

  • Direct secure messaging: codom54737@direct.metrohealth.org

Organizations & group practices 8

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.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1364688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694476800000",
    "number": "1740523513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12554 RIATA VISTA CIR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787276431",
            "telephone_number": "512-795-5100",
            "fax_number": "512-795-5122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 W HAYS ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837025511",
            "telephone_number": "208-381-2094",
            "fax_number": "208-381-1791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODOM",
        "first_name": "CARL",
        "middle_name": "IRWIN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-03-31",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "T0301",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371653203",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.