Active NPI
Alexander James O'Dea, PA-C
- Physician Assistant
- Bradenton, FL
National Provider Identifier
1922688605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9114277
- Practice address
- 8000 FL 64
Bradenton, FL 34212 - Phone
- (941) 792-1404
- Fax
- (941) 761-0712
- NPI assigned
- Apr 8, 2021
- Last updated
- Oct 11, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9114277 | FL | Primary |
Addresses
Primary practice location
8000 FL 64
Bradenton, FL 34212
Mailing address
8000 FL 64
Bradenton, FL 34212
Phone (941) 792-1404
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1630 Dry Creek Dr
Longmont, CO 80503-6422
Phone (720) 279-9098
1630 Dry Creek Dr
Suite 200
Longmont, CO 80503-6405
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9114277 | FL | MD | Physician Assistant |
Interoperability endpoints
- alexander.o.dea.1@31554.direct.athenahealth.com
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- Longmont, CO
- NPI 1982958435
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728604800000",
"number": "1922688605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8000 FL 64",
"city": "BRADENTON",
"state": "FL",
"postal_code": "34212",
"telephone_number": "941-792-1404",
"fax_number": "941-761-0712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8000 FL 64",
"city": "BRADENTON",
"state": "FL",
"postal_code": "34212",
"telephone_number": "941-792-1404",
"fax_number": "941-761-0712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'DEA",
"first_name": "ALEXANDER",
"middle_name": "JAMES",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-04-08",
"last_updated": "2024-10-11",
"certification_date": "2024-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9114277",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bradenton, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 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.