Crystal Noel Odegard, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1982 Issued in ID

Practice address

1079 S Ancona Ave Ste 100
Eagle, ID 83616-7443

Phone

(208) 853-2273

NPI assigned

Apr 7, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Sep 9, 2021 through Sep 9, 2027

Medicare enrollment (NPD)

Not enrolled

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.

• Preventative Health

  • Family Nurse Practitioner
  • Eagle, ID
  • NPI 1922377027
  NPD
• Epic Psychological Services, PLLC

  • Psychologist
  • Meridian, ID
  • NPI 1861759854
  NPD (past)
• Scott P. Hoopes, M.D., P.a.

  • Psychiatry Physician
  • Meridian, ID
  • NPI 1891816823
  NPD (past)

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

{
    "created_epoch": "1617753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1962081810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1652 W SUNNY SLOPE DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836424336",
            "telephone_number": "541-285-4851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1079 S ANCONA AVE STE 100",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836167443",
            "telephone_number": "208-853-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODEGARD",
        "first_name": "CRYSTAL",
        "middle_name": "NOEL",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-07",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sydney Nuttall, FNP-C
• Nview Behavioral Health Clinic of Idaho LLC
• Erin Rae O'Brien
• Oasis Pediatrics
• Amy Ochs, M.S., CCC-SLP
• Patricia Oleary, PTA
• Onyx Health & Med
• Optimal Healthcare PLLC
• Megan Irene Osborne, PH.D, LPC
• Stacy Diane Ostler, MD

• Physician Assistant in Eagle, ID
• Providers in Eagle, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.