Individual provider Active NPI

Amber Odo, PT

  • Physical Therapist
  • Puyallup, WA
National Provider Identifier
1912624412
Registry record updated Dec 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
61328945 Issued in WA
Practice address
1007 39TH Ave SE
Puyallup, WA 98374-2192
Phone
(253) 435-3170
NPI assigned
Oct 25, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 61328945 WA Primary

Addresses

Primary practice location

1007 39TH Ave SE
Puyallup, WA 98374-2192

Mailing address

3209 E F St
Tacoma, WA 98404-1630
Phone (808) 859-9780

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221123000541 WA Practitioner - Physical Therapist in Private Practice 8820466824 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1007 39TH Ave SE
Puyallup, WA 98374-2192
Phone (253) 435-3100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
61328945WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington CurrentSince Nov 1, 2022 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Nov 1, 2022 Accepting new patients

Locations

1007 39th Ave SE
Puyallup, WA 98374
Phone (253) 435-3100

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

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.

NPI Registry JSON

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

{
    "created_epoch": "1666656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670457600000",
    "number": "1912624412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3209 E F ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984041630",
            "telephone_number": "808-859-9780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 39TH AVE SE",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983742192",
            "telephone_number": "253-435-3170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODO",
        "first_name": "AMBER",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-25",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "61328945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1007 39th Ave SE",
            "city": "Puyallup",
            "state": "WA",
            "country_code": "US",
            "postal_code": "983742192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.