NPIMap

Individual provider Active NPI

Marek A Odehnal, MD

  • Internal Medicine Physician
  • Longmont, CO
National Provider Identifier
1780643262
Registry record updated Nov 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DR.0053285 Issued in CO
Practice address
1925 Mountain View Ave
Longmont, CO 80501-3128
Phone
(720) 494-3126
Fax
(720) 718-8025
NPI assigned
Mar 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01060578 IN
Internal Medicine Physician 207R00000X DR.0053285 CO Primary

Addresses

Primary practice location

1925 Mountain View Ave
Longmont, CO 80501-3128

Mailing address

1925 Mountain View Ave
Longmont, CO 80501-3128
Phone (720) 494-3126

Other identifiers 2

IdentifierTypeStateIssuer
200807010AMedicaidIN
30103886MedicaidCO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140909002528 CO Practitioner - Internal Medicine 6103851415 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1925 Mountain View Ave
Longmont, CO 80501-3128
Phone (303) 776-1234

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Colorado Springs, CO, CCN 067129
  • Longs Peak Hospital Hospital, Longmont, CO, CCN 060128
  • University of Colorado Hospital Authority Hospital, Aurora, CO, CCN 060024
  • Uchealth Broomfield Hospital Hospital, Broomfield, CO, CCN 060129
  • Uchealth Greeley Hospital Hospital, Greeley, CO, CCN 060131
  • Boulder Community Health Hospital, Boulder, CO, CCN 060027

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0053285COMDInternal Medicine Physician
01060578INMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Current Accepting new patients
Portercare Adventist Health System Current Accepting new patients
Portercare Adventist Health System CurrentSince Jan 1, 2019 Accepting new patients
Portercare Adventist Health System CurrentSince Jan 1, 2019 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Nov 8, 2021 Accepting new patients
Franciscan Medical Specialists Internal Medicine Past Accepting new patients

Locations

2750 Broadway St
Boulder, CO 80304
Phone (303) 440-3000

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

7750 S Broadway
Ste 260
Littleton, CO 80122
Phone (303) 734-8650

2030 Mountain View Ave
Ste 300
Longmont, CO 80501
Phone (720) 652-8650

1925 Mountain View Ave
Longmont, CO 80501
Phone (303) 776-1234

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

Organizations & group practices 6

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 65

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

View all 65

NPI Registry JSON

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

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636070400000",
    "number": "1780643262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 MOUNTAIN VIEW AVE",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805013128",
            "telephone_number": "720-494-3126",
            "fax_number": "720-718-8025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 MOUNTAIN VIEW AVE",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805013128",
            "telephone_number": "720-494-3126",
            "fax_number": "720-718-8025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODEHNAL",
        "first_name": "MAREK",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-22",
        "last_updated": "2021-11-05",
        "certification_date": "2021-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01060578",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR.0053285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200807010A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30103886",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

Verify at the official NPI Registry.