NPIMap

Individual provider Active NPI

Nkenna Odom, MD

  • Family Medicine Physician
  • Providence, RI
National Provider Identifier
1972098465
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD17589 Issued in RI
Practice address
1195 North Main Street
Cnemg Primary Care WMC
Providence, RI 02904-0288
Phone
(401) 736-4562
Fax
(401) 921-9864
NPI assigned
Jun 27, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD17589 RI Primary

Addresses

Primary practice location

1195 North Main Street
Cnemg Primary Care WMC
Providence, RI 02904-0288

Mailing address

455 Toll Gate Rd
PRC and Credentialing
Warwick, RI 02886-2759
Phone (401) 273-0641

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210713002742 RI Practitioner - Family Practice 1153723119 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Affinity Physicians LLC.Group PAC ID 0244413391, 723 clinicians

Practice addresses (Care Compare)

455 Toll Gate Rd
Warwick, RI 02886-2759
Phone (401) 737-7010

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Medical Physicians, Inc. Family Medicine CurrentSince Apr 1, 2024 Accepting new patients
The Miriam Hospital CurrentSince Aug 31, 2021 Accepting new patients
The Miriam Hospital Family Medicine Current Accepting new patients
Affinity Physicians LLC CurrentSince Feb 1, 2025 Accepting new patients
Affinity Physicians LLC. Family Medicine Current Accepting new patients
Coastal Medical Physicians, Inc. CurrentSince Apr 1, 2024 Accepting new patients
The Miriam Hospital Current Accepting new patients
The Miriam Hospital CurrentSince Aug 31, 2021 Accepting new patients
The Miriam Hospital Current Accepting new patients

Locations

900 Warren Ave
Ste 401
East Providence, RI 02914
Phone (401) 330-2480

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

1195 N Main St
Providence, RI 02904
Phone (401) 654-4433

146 W River St
Ste 11C
Providence, RI 02904
Phone (401) 606-3000

146 W River St
Providence, RI 02904
Phone (401) 444-7442

146 W River St
Fl 3
Providence, RI 02904
Phone (401) 793-5700

455 Toll Gate Rd
Warwick, RI 02886
Phone (401) 737-7000

Interoperability endpoints

  • Direct secure messaging: nodom@direct.carene.org

Organizations & group practices 9

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1530057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1972098465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 TOLL GATE RD",
            "address_2": "PRC AND CREDENTIALING",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028862759",
            "telephone_number": "401-273-0641",
            "fax_number": "401-273-2919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1195 NORTH MAIN STREET",
            "address_2": "CNEMG PRIMARY CARE WMC",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029040288",
            "telephone_number": "401-736-4562",
            "fax_number": "401-921-9864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODOM",
        "first_name": "NKENNA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-27",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "RI",
            "license": "MD17589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.