NPIMap

Individual provider Active NPI

Jennifer Odren, D.O.

  • Nephrology Physician
  • Saint Clair Shores, MI
National Provider Identifier
1821384249
Registry record updated Oct 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
5101018974 Issued in MI
Practice address
29001 Harper Ave
Saint Clair Shores, MI 48081-2711
Phone
(586) 778-0664
Fax
(586) 778-0396
NPI assigned
Jun 23, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2015

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 L1828783 MI
Nephrology Physician 207RN0300X 5101018974 MI Primary

Addresses

Primary practice location

29001 Harper Ave
Saint Clair Shores, MI 48081-2711

Mailing address

48 Fairwood Blvd
Pleasant Ridge, MI 48069-1217
Phone (586) 362-4224

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20150521002130 MI Practitioner - NephrologyPractitioner - Internal MedicinePractitioner - Neurology 4789904376 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Michigan State University College of Osteopathic Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kidney Care Specialists of Michigan PCGroup PAC ID 5597940080, 3 clinicians

Practice addresses (Care Compare)

29001 Harper Ave
Saint Clair Shores, MI 48081-2711
Phone (586) 778-0664

Hospital & facility affiliations

  • FMC - St Clair Shores Dialysis facility, Harper Woods, MI, CCN 232615
  • Dialysis Centers of Michigan Dialysis facility, Eastpointe, MI, CCN 232712
  • FMC Dialysis - East Detroit Dialysis facility, Detroit, MI, CCN 232503
  • Beaumont Hospital - Grosse Pointe Hospital, Grosse Pointe, MI, CCN 230089
  • Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165
  • Henry Ford Macomb Hospital Hospital, Clinton Township, MI, CCN 230047
  • Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130
  • Beaumont Hospital, Troy Hospital, Troy, MI, CCN 230269

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L1828783MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kidney Care Specialists of Michigan PC Nephrology CurrentSince Aug 24, 2015 Accepting new patients

Locations

15855 19 Mile Rd
Clinton Twp, MI 48038
Phone (586) 263-2300

29001 Harper Ave
St Clr Shores, MI 48081
Phone (586) 778-0664

33200 Dequindre Rd
Ste 200
Sterling Hts, MI 48310
Phone (586) 772-3500

Interoperability endpoints

  • Direct secure messaging: jodren250894@direct.hfhs.org

Organizations & group practices 1

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 10

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

NPI Registry JSON

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

{
    "created_epoch": "1308787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445904000000",
    "number": "1821384249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 FAIRWOOD BLVD",
            "city": "PLEASANT RIDGE",
            "state": "MI",
            "postal_code": "480691217",
            "telephone_number": "586-362-4224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29001 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480812711",
            "telephone_number": "586-778-0664",
            "fax_number": "586-778-0396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODREN",
        "first_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-23",
        "last_updated": "2015-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "L1828783",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MI",
            "license": "5101018974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

Verify at the official NPI Registry.