| John Odom, MD | |
|
6545 Flying Cloud Dr Ste 201, Eden Prairie, MN 55344-3356 | |
| (952) 224-1919 | |
| (763) 710-8154 |
| Full Name | John Odom |
|---|---|
| Gender | Male |
| Speciality | Family Practice |
| Experience | 26 Years |
| Location | 6545 Flying Cloud Dr Ste 201, Eden Prairie, Minnesota |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215953732 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207P00000X | Emergency Medicine | 44235 (Minnesota) | Secondary |
| 2081S0010X | Physical Medicine & Rehabilitation - Sports Medicine | 44235 (Minnesota) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Odom Sports Medicine Pa | 0143485607 | 66 |
| Entity Name | Ccm Health |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1720086028 PECOS PAC ID: 4284539453 Enrollment ID: O20031201000642 |
| Entity Name | Hennepin County |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1780790345 PECOS PAC ID: 7911892849 Enrollment ID: O20040218001012 |
| Entity Name | St Francis Medical Center |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1891954574 PECOS PAC ID: 8123937992 Enrollment ID: O20040429000995 |
| Entity Name | Sanford Health Network |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1699869875 PECOS PAC ID: 6800707100 Enrollment ID: O20040715001116 |
| Entity Name | Sanford Health Network |
|---|---|
| Entity Type | Part A Provider - Critical Access Hospital |
| Entity Identifiers | NPI Number: 1780781054 PECOS PAC ID: 6800707100 Enrollment ID: O20061213000244 |
| Entity Name | Odom Sports Medicine Pa |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1275557886 PECOS PAC ID: 0143485607 Enrollment ID: O20120706000533 |
| Entity Name | Carris Health - Redwood Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1265914048 PECOS PAC ID: 7911259619 Enrollment ID: O20181129001082 |
| Mailing Address | Practice Location Address |
|---|---|
| John Odom, MD 6390 Pleasant View Cv, Chanhassen, MN 55317-9263 Ph: (952) 906-2011 | John Odom, MD 6545 Flying Cloud Dr Ste 201, Eden Prairie, MN 55344-3356 Ph: (952) 224-1919 |