Individual provider Active NPI

Teresa Marie O'Dea, MD

  • Pediatrics Physician
  • San Diego, CA
National Provider Identifier
1760450522
Registry record updated Sep 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A65049 Issued in CA
Practice address
2001 4TH Ave
San Diego, CA 92101-2303
Phone
(619) 446-1727
NPI assigned
Mar 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A65049 CA Primary

Addresses

Primary practice location

2001 4TH Ave
San Diego, CA 92101-2303

Mailing address

10670 Wexford St
San Diego, CA 92131-3940
Phone (858) 499-2701

Other identifiers 1

IdentifierTypeStateIssuer
A65049OtherCAMD LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130222000198 CA Practitioner - Pediatric Medicine 7315192382 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sharp Rees-Stealy Medical Group, Inc Pediatrics CurrentSince Jan 7, 2013 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc CurrentSince Jan 7, 2013 Accepting new patients
Scripps Health Past Accepting new patients
Sharp Rees-Stealy Medical Center Past Accepting new patients
Sharp Memorial Hospital Past Accepting new patients
Sharp Memorial Hospital Past Accepting new patients
Rady Children'S Hospital San Diego Past Accepting new patients

Locations

10670 Wexford St
San Diego, CA 92131
Phone (858) 621-4010

2020 Genesee Ave
San Diego, CA 92123
Phone (619) 268-9500

Interoperability endpoints

  • Direct secure messaging: todea32716@sharphealthcare.direct-ci.com

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379462400000",
    "number": "1760450522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10670 WEXFORD ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921313940",
            "telephone_number": "858-499-2701",
            "fax_number": "858-621-4070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 4TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012303",
            "telephone_number": "619-446-1727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'DEA",
        "first_name": "TERESA MARIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-09",
        "last_updated": "2013-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A65049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD LICENSE",
            "identifier": "A65049",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.