NPIMap

Organization Active NPI

Odom Sports Medicine, P.a.

Doing business as Odom Health and Wellness

  • Sports Medicine (Family Medicine) Physician
  • Waconia, MN
National Provider Identifier
1740625870
Registry record updated May 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
Legal business name
ODOM SPORTS MEDICINE, P.A.
Doing business as
Odom Health and Wellness
Practice address
500 S Cherry St
Waconia, MN 55387-4515
Phone
(952) 856-4722
NPI assigned
May 2, 2013
Organization subpart
Yes
Parent organization
ODOM SPORTS MEDICINE, P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 2, 2013

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

Authorized official

Name
Dr. John H.L. Odom Jr., M.D.NPI 1215953732
Title
President
Phone
(952) 224-1919

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

500 S Cherry St
Waconia, MN 55387-4515

Mailing address

10500 Wayzata Blvd
Minnetonka, MN 55305-1511
Phone (952) 224-1919

Other names 1

  • Odom Health and Wellness Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Odom Sports Medicine PA4 organizations share this tax ID, including this one
Part of
Odom Sports Medicine PA

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

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": "1367452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367452800000",
    "number": "1740625870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10500 WAYZATA BLVD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553051511",
            "telephone_number": "952-224-1919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S CHERRY ST",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553874515",
            "telephone_number": "952-856-4722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ODOM SPORTS MEDICINE, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ODOM SPORTS MEDICINE, P.A.",
        "enumeration_date": "2013-05-02",
        "last_updated": "2013-05-02",
        "status": "A",
        "authorized_official_last_name": "ODOM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "H.L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-224-1919",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Odom Health and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waconia, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.