Colleen Odonnell, P.A.

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

6526009-1206 Issued in UT

Practice address

2132 N 1700 W Ste 230
Layton, UT 84041-7060

Phone

(801) 773-3900

Fax

(801) 773-3900

NPI assigned

Oct 24, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in UT

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Physician Group of Utah Inc

  • Specialist
  • South Jordan, UT
  • NPI 1477676930
  Medicare reassignment NPD
• Davidson Orthopedics LLC

  • Orthopaedic Surgery Physician
  • Salt Lake City, UT
  • NPI 1821468109
  NPD (past)
• Davis Hospital Holdings, Inc.

  • Contractor
  • Layton, UT
  • NPI 1851333249
  NPD (past)
• Hofmann Arthritis Institute, PLLC

  • Orthopaedic Surgery Physician
  • Salt Lake City, UT
  • NPI 1215248612
  NPD (past)

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1942290804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4017 N WOLF CREEK DR",
            "city": "EDEN",
            "state": "UT",
            "postal_code": "843109894",
            "telephone_number": "801-690-6456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2132 N 1700 W STE 230",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840417060",
            "telephone_number": "801-773-3900",
            "fax_number": "801-773-3900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1407 N 2000 W Ste F",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "UT",
            "postal_code": "840158563",
            "country_code": "US",
            "telephone_number": "801-773-3900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODONNELL",
        "first_name": "COLLEEN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-24",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "007859-1",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "UT",
            "license": "6526009-1206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02108996",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deidra Ann Oberhansly
• John Jensen Oberhansly
• Kelby J Oberhansly
• Occupational Health Centers of the Southwest, P.a. (Ut)
• Occupational Health Centers of the Southwest, P.a. (Ut)
• Daniel Offret, PA-C
• Ogden Internal Medicine and Urology
• Ogden Orthopaedic Specialists, LLC
• Brynlie Ogden
• Orin H Ogilvie, MD

• Surgical Physician Assistant in Layton, UT
• Providers in Layton, UT by specialty
• Surgical Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.