Active NPI
Shepherd A Odom, MD
- Family Medicine Physician
- Montgomery, AL
National Provider Identifier
1881736346
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(3) exclusion effective Apr 18, 2019.
- Section 1128b(4) exclusion effective Jun 20, 2018.
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 00005590
- Practice address
- 4143 Atlanta Highway
Family Practice
Montgomery, AL 36109 - Phone
- (334) 271-4503
- Fax
- (334) 277-3215
- NPI assigned
- Feb 13, 2007
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 00005590 | AL | Primary |
Addresses
Primary practice location
4143 Atlanta Highway
Family Practice
Montgomery, AL 36109
Mailing address
4143 Atlanta Highway
Family Practice
Montgomery, AL 36109
Phone (334) 271-4503
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5590 | AL | MD | Dentist |
| 00005590 | AL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881736346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4143 ATLANTA HIGHWAY",
"address_2": "FAMILY PRACTICE",
"city": "MONTGOMERY",
"state": "AL",
"postal_code": "36109",
"telephone_number": "334-271-4503",
"fax_number": "334-277-3215"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4143 ATLANTA HIGHWAY",
"address_2": "FAMILY PRACTICE",
"city": "MONTGOMERY",
"state": "AL",
"postal_code": "36109",
"telephone_number": "334-271-4503",
"fax_number": "334-277-3215"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODOM",
"first_name": "SHEPHERD",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AL",
"license": "00005590",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montgomery, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.