Keith Wayne Odendahl, N.P.

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

AP03719 Issued in LA

Practice address

7777 Hennessy Blvd
Suite1000
Baton Rouge, LA 70808-4300

Phone

(225) 767-3900

Fax

(225) 214-9109

NPI assigned

Jan 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in LA, MS2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Our Lady of the Lake Physician Group LLCGroup PAC ID 4587849781, 637 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Our Lady of the Lake Regional Medical Center Hospital, Baton Rouge, LA, CCN 190064

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations (25 of 47)

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.

• Our Lady of the Lake Physician Group LLC

  • Internal Medicine Physician
  • Baton Rouge, LA
  • NPI 1033494943

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Coastal Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Gonzales, LA
  • NPI 1568601425
  Medicare reassignment NPD
• Convenient Care LLC

  • Urgent Care Clinic/Center
  • Baton Rouge, LA
  • NPI 1164422630
  Medicare reassignment NPD
• DM Properties of Lafayette, LLC

  • Urgent Care Clinic/Center
  • Alexandria, LA
  • NPI 1659613537
  Medicare reassignment NPD
• Hulin Urgent Care Services LLC

  • Urgent Care Clinic/Center
  • New Iberia, LA
  • NPI 1699049262
  Medicare reassignment NPD
• In and Out Urgent Care Covington, LLC

  • Urgent Care Clinic/Center
  • Covington, LA
  • NPI 1366926040
  Medicare reassignment NPD
• In and Out Urgent Care, LLC

  • Urgent Care Clinic/Center
  • New Orleans, LA
  • NPI 1851725154
  Medicare reassignment NPD
• St. John Emergency Group LLC

  • Emergency Medicine Physician
  • La Place, LA
  • NPI 1265401509

  Nurse Practitioner

  Medicare reassignment NPD
• App of Mississippi Ed, LLC

  • Emergency Medicine Physician
  • Jackson, MS
  • NPI 1730687740
  Medicare reassignment NPD
• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Ripley, MS
  • NPI 1447769559

  Nurse Practitioner

  Medicare reassignment NPD
• Pascagoula Urgent Care

  • Urgent Care Clinic/Center
  • Pascagoula, MS
  • NPI 1235442872
  Medicare reassignment NPD
• Convenient Care LLC

  • Urgent Care Clinic/Center
  • Hammond, LA
  • NPI 1225119225
  NPD

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

• Our Lady of the Lake Hospital Inc.

  • General Acute Care Hospital
  • Baton Rouge, LA
  • NPI 1366436123
  Care Compare affiliation

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

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1811977846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 BURTON HILLS BLVD",
            "address_2": "STE 175",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156403",
            "telephone_number": "615-988-2014",
            "fax_number": "615-864-7565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 HENNESSY BLVD",
            "address_2": "SUITE1000",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084300",
            "telephone_number": "225-767-3900",
            "fax_number": "225-214-9109"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5439 Airline Hwy",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708051712",
            "country_code": "US",
            "telephone_number": "225-358-4853",
            "fax_number": "225-358-2350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODENDAHL",
        "first_name": "KEITH",
        "middle_name": "WAYNE",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-17",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "LA",
            "license": "AP03719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCARE THRU PEPA",
            "identifier": "P00712670",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1431940",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "310063",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ochsner Pharmacy and Wellness LLC
• Ochsner Pharmacy and Wellness LLC
• Ochsner Pharmacy and Wellness LLC
• Tamara Odeh
• David Odendahl
• Anne Patrice Odenweller, DC
• Casey Corner Odo, PA-C
• Leandre Odom Jr.
• Ma'Kayla Odom
• Taylor Jene' Odom, LPC

• Adult Health Nurse Practitioner in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Adult Health Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2024; 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.

Verify at the official NPI Registry.