Individual provider Active NPI

Benta Achieng Odipo, AGACNP

  • Nurse Practitioner
  • Memphis, TN
National Provider Identifier
1821821125
Registry record updated Aug 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
36152 Issued in TN
Practice address
877 Jefferson Ave
Memphis, TN 38103-2807
Phone
(901) 545-7100
NPI assigned
Aug 22, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 36152 TN Primary

Addresses

Primary practice location

877 Jefferson Ave
Memphis, TN 38103-2807

Mailing address

877 Jefferson Ave
Memphis, TN 38103-2807
Phone (901) 545-7100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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 1

Enrollment IDStateProvider typePAC IDDetails
I20241206001503 TN Practitioner - Nurse Practitioner 2466988928 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ut Regional One Physicians IncGroup PAC ID 5698993418, 314 clinicians

Practice addresses (Care Compare)

877 Jefferson Ave
Memphis, TN 38103-2807
Phone (901) 545-8336

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
36152TNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ut Regional One Physicians Inc CurrentSince Oct 1, 2024 Accepting new patients
Ut Regional One Physicians Inc Nurse Practitioner CurrentSince Oct 1, 2024 Accepting new patients

Locations

6215 Humphreys Blvd
Ste 201
Memphis, TN 38120
Phone (901) 866-8085

877 Jefferson Ave
Memphis, TN 38103
Phone (901) 448-5893

Organizations & group practices 2

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 1

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": "1724284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724284800000",
    "number": "1821821125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "877 JEFFERSON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381032807",
            "telephone_number": "901-545-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "877 JEFFERSON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381032807",
            "telephone_number": "901-545-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODIPO",
        "first_name": "BENTA",
        "middle_name": "ACHIENG",
        "credential": "AGACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-22",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "36152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.