Kenneth Franklin Odom, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA.504 Issued in AL

Practice address

1500 Ross Clark Cir
Dothan, AL 36301-4754

Phone

(334) 793-2663

Fax

(334) 836-2247

NPI assigned

Jul 11, 2006

Last updated

Oct 29, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in AL

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

Specialty

Physician Assistant

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

S.B.J.S. PCGroup PAC ID 8527043421, 39 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Flowers Hospital Hospital, Dothan, AL, CCN 010055
• Southeast Health Medical Center Hospital, Dothan, AL, CCN 010001

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kenneth.odom.1@15455.direct.athenahealth.com

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.

• SBJS PC

  dba Southern Bone & Joint Specialists

  • Orthopaedic Surgery Physician
  • Dothan, AL
  • NPI 1134106065
  Medicare reassignment Care Compare group NPD
• S.B.J.S. PC

  dba Southern Bone & Joint Specialists

  • Durable Medical Equipment & Medical Supplies
  • Dothan, AL
  • NPI 1972824993
  NPD
• S.B.J.S. PC

  dba Southern Bone & Joint Specialists

  • Durable Medical Equipment & Medical Supplies
  • Dothan, AL
  • NPI 1629252499
  NPD (past)
• Hospital Authority of the City of Bainbridge and Decatur County

  dba Memorial Hospital and Manor

  • Multi-Specialty Clinic/Center
  • Bainbridge, GA
  • NPI 1053388256
  NPD (past)

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

• Houston County Healthcare Authority

  dba Southeast Alabama Medical Center

  • General Acute Care Hospital
  • Dothan, AL
  • NPI 1164403861
  Care Compare affiliation
• Triad of Alabama LLC

  dba Flowers Hospital

  • General Acute Care Hospital
  • Dothan, AL
  • NPI 1801830500
  Care Compare affiliation

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446076800000",
    "number": "1982639738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 729",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363020729",
            "telephone_number": "334-793-2663",
            "fax_number": "334-836-2247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 ROSS CLARK CIR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363014754",
            "telephone_number": "334-793-2663",
            "fax_number": "334-836-2247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODOM",
        "first_name": "KENNETH",
        "middle_name": "FRANKLIN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2015-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "PA.504",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003140733A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121885",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003140729A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009940319",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "0515580730",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF AL - HEALTHWEST",
            "identifier": "511-09068",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF AL - RCC",
            "identifier": "515-37977",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenna Oates, ARNP
• Adirika Justin Obiako
• Robert Michael Obrien, MD
• Obstetrics & Gynecology of Dothan Inc (Ladies First)
• Occmed Solutions LLC
• Theresa Bryant Odum, OCCUPATIONAL THERAPY
• Osakpolor Ogbebor, M.D
• Abolaji Oladapo, PHARM.D
• Katherine Blythe Oakley Olson, DO
• Craig Dean Omohundro, MD

• Physician Assistant in Dothan, AL
• Providers in Dothan, AL by specialty
• Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2015; 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.

Verify at the official NPI Registry.