Odyssey Family Practice

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ODYSSEY FAMILY PRACTICE

Practice address

11595 Kenai Spur Highway
Kenai, AK 99611

Phone

(907) 313-4569

Fax

(907) 313-4939

NPI assigned

Mar 6, 2019

Organization subpart

No

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

Authorized official

Name

Jared Lee Wallace, PA-CNPI 1063746667

Title

Owner

Phone

(907) 313-4569

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AK, TX2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Odyssey Urgent Care and Occupational Health

  • Urgent Care Clinic/Center
  • Kenai, AK
  • NPI 1265203160

  O20200129002758

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/BIHGBD

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jared Lee Wallace, PA-C

  • Physician Assistant
  • Kenai, AK
  • NPI 1063746667
  Medicare reassignment Care Compare group NPD Authorized official
• Sarah Ashley Kurka, PA-C

  • Physician Assistant
  • Kenai, AK
  • NPI 1649167453
  Medicare reassignment Care Compare group NPD
• Chris L Shults, PA-C

  • Medical Physician Assistant
  • Kenai, AK
  • NPI 1245428770
  Medicare reassignment Care Compare group NPD
• Megan Lynn Stanley, PA-C

  • Physician Assistant
  • Bethel, AK
  • NPI 1245992312
  Medicare reassignment Care Compare group NPD
• Jerry Ross Tanner II, D.O.

  • Endocrinology, Diabetes & Metabolism Physician
  • Anchorage, AK
  • NPI 1962580480
  Medicare reassignment Care Compare group NPD
• Norvin Perez, MD

  • Non-Pharmacy Dispensing Site
  • Juneau, AK
  • NPI 1346235819
  Medicare reassignment NPD
• Timothy W Miller, DO

  • Family Medicine Physician
  • Anchorage, AK
  • NPI 1326275082
  NPD

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

{
    "created_epoch": "1551830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764547200000",
    "number": "1780142042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 922",
            "city": "KASILOF",
            "state": "AK",
            "postal_code": "996100922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11595 KENAI SPUR HIGHWAY",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "99611",
            "telephone_number": "907-313-4569",
            "fax_number": "907-313-4939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ODYSSEY FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-06",
        "last_updated": "2025-12-01",
        "certification_date": "2025-12-01",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "JARED",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-313-4569",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawn Marie Nusharr
• Roberta O'Brien
• Annette Cameron O'Connell, M.S., CCC-SLP
• Robert D O'Connell, OD
• Occupational Rehabilitative Services Inc
• Odyssey Urgent Care and Occupational Health
• Diane Carol Ogilvie
• Kaija T Okkonen
• Miriam Alejandra Olivo
• Darlene Charmaine Olsen-Holst

• Family Medicine Physician in Kenai, AK
• Providers in Kenai, AK by specialty
• Family Medicine Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.