Active NPI
Albert E Odom Jr., MD
- Gynecology Physician
- Columbia, SC
National Provider Identifier
1790737997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- 12029
- Practice address
- 300 Palmetto Health Pkwy Ste 300
Columbia, SC 29212-1763 - Phone
- (803) 907-7300
- Fax
- (803) 907-7309
- NPI assigned
- May 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 12029 | SC | Primary |
Addresses
Primary practice location
300 Palmetto Health Pkwy Ste 300
Columbia, SC 29212-1763
Mailing address
PO Box 743904
Atlanta, GA 30374-3904
Phone (803) 296-7320
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 120292 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120301000925 | SC | Practitioner - Obstetrics/Gynecology | 0840459368 | Reassigns benefits to 3 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Obstetrics/Gynecology
- Education
- University of South Carolina School of Medicine, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Prisma Health Medical Group-Midlands
Practice addresses (Care Compare)
300 Palmetto Health Pkwy
Suite 300
Columbia, SC 29212-1763
Phone (803) 907-7300
Hospital & facility affiliations
- Prisma Health Baptist Parkridge
- Prisma Health Baptist
- Prisma Health Richland Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of the uterus | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12029 | SC | MD | Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prisma Health Medical Group-Midlands | Current | Accepting new patients | |
| Prisma Health Medical Group-Midlands | Current | Accepting new patients | |
| Prisma Health-Midlands | Current | Accepting new patients | |
| Prisma Health-Midlands | Current | Accepting new patients | |
| Obhg South Carolina PC | Current | Accepting new patients |
Locations
400 Palmetto Health Pkwy
Columbia, SC 29212
Phone (803) 296-5579
1301 Taylor St
Ste 6J
Columbia, SC 29201
Phone (803) 296-2942
2 Medical Park Rd
Ste 506
Columbia, SC 29203
Phone (803) 434-3930
300 Palmetto Health Pkwy
Ste 300
Columbia, SC 29212
Phone (803) 907-7300
9330 Medical Plaza Dr
North Charleston, SC 29406
Phone (843) 554-6366
Interoperability endpoints
- aodom382912@direct.ghs.myhfn.org
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.
-
- Durable Medical Equipment & Medical Supplies
- Columbia, SC
- NPI 1568959872
-
- Durable Medical Equipment & Medical Supplies
- Columbia, SC
- NPI 1881469856
-
- General Acute Care Hospital
- Columbia, SC
- NPI 1811237985
Hospital & facility affiliations 10
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Geriatric Medicine (Internal Medicine) Physician
- Columbia, SC
- NPI 1962471946
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522800000000",
"number": "1790737997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 743904",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303743904",
"telephone_number": "803-296-7320",
"fax_number": "803-296-7330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 PALMETTO HEALTH PKWY STE 300",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292121763",
"telephone_number": "803-907-7300",
"fax_number": "803-907-7309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODOM",
"first_name": "ALBERT",
"middle_name": "E",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-16",
"last_updated": "2018-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "SC",
"license": "12029",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "120292",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.