ODOM SPORTS MEDICINE, P.A. (NPI# 1740625870) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740625870 |
| Entity Type | Organization |
| Organization Name | ODOM SPORTS MEDICINE, P.A. |
| Other Organization Name | ODOM HEALTH AND WELLNESS |
| Practice Address |
500 S Cherry St Waconia MN 55387-4515 |
| Mailing Address |
10500 Wayzata Blvd Minnetonka MN 55305-1511 |
| Practice Telephone | 9528564722 |
| Mailing Telephone | 9522241919 |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2013-05-02 |
| Authorized Official Name | DR. JOHN H.L. ODOM JR. (PRESIDENT) |
| Authorized Official Telephone | 9522241919 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | ODOM SPORTS MEDICINE, P.A. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 225X00000X | Occupational Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Odom Health and Wellness | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275557886 | Odom Sports Medicine, P.a. | Family Medicine | 10653 Wayzata Blvd Ste 200, Minnetonka, MN 55305-1543 | 2006-07-27 |
| Street Address |
500 S CHERRY ST |
| City | WACONIA |
| State | MN |
| Zip Code | 55387-4515 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851505853 | Waconia Ops. LLC | Assisted Living Facility | 500 S Cherry St, Waconia, MN 55387-4515 | 2007-05-09 |
| 1780248419 | Amanda Lane | Occupational Therapist | 500 S Cherry St, Waconia, MN 55387-4515 | 2019-04-29 |
| 1700328739 | Loretta Jaeger | Speech-Language Pathologist | 500 S Cherry St, Waconia, MN 55387-4515 | 2016-11-08 |
| 1316299068 | Toni Van Eyll | Occupational Therapist | 500 S Cherry St, Waconia, MN 55387-4515 | 2012-10-04 |
| 1821347568 | Pam Gillund | Occupational Therapist | 500 S Cherry St, Waconia, MN 55387-4515 | 2012-09-07 |
| 1245596196 | Meghan Alyssa Klein | Physical Therapist | 500 S Cherry St, Waconia, MN 55387-4515 | 2012-04-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023626256 | Katelyn Neufeld | Midwife | Western Obgyn 560 S Maple St, Suite 130, Waconia, MN 55387 | 2020-07-14 |
| 1871074674 | Ashley Bea Johnson | Registered Nurse | 1866 Sandbar Cir, Waconia, MN 55387 | 2018-08-28 |
| 1740642529 | Ryan Christenson | Chiropractor | 32 E Main St., Waconia, MN 55387 | 2016-03-22 |
| 1942638481 | Katie Elizabeth Leuning-pavek | Marriage & Family Therapist | 1657 Interlaken Ct, Waconia, MN 55387 | 2013-10-18 |
| 1083964837 | Auburn Meadows, LLC | Assisted Living Facility | 591 S. Cherry Dr, Waconia, MN 55387 | 2012-09-19 |
| 1114238821 | Jalissa Joy Kruckman | Dentist | 576 Cherry Dr, Waconia, MN 55387 | 2010-06-28 |
| 1194990143 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 121 Depot Dr, Waconia, MN 55387 | 2008-04-29 |
| 1417156662 | Heather Anne Noel Tuttle | Optometrist | 753 Marketplace Drive, Waconia, MN 55387 | 2007-07-17 |
| 1366507436 | Waconia School District | Local Education Agency (LEA) | 512 Industrial Blvd, Waconia, MN 55387 | 2006-12-27 |
| 1295898872 | Haven Chemical Health Systems | Counselor | 233 1st St W, Waconia, MN 55387 | 2006-12-18 |
| Find all providers in zip 55387 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316239361 | David Ian Smith | Family Medicine | 516 15th Ave Se Ste 190e, Minneapolis, MN 55455-0130 | 2011-05-10 |
| 1306163571 | Maria Christine Ryan | Family Medicine | 15450 Highway 7 Ste 125, Minnetonka, MN 55345-3522 | 2010-04-28 |
| 1659437267 | Peter Swann | Family Medicine | 1400 Corporate Center Curv Ste 200, Eagan, MN 55121-1372 | 2006-12-28 |
| 1275557886 | Odom Sports Medicine, P.a. | Family Medicine | 10653 Wayzata Blvd Ste 200, Minnetonka, MN 55305-1543 | 2006-07-27 |
| 1790739092 | Ronald Wayne Hanson Jr. | Family Medicine | 6636 Cedar Ave S Ste 170, Richfield, MN 55423-2710 | 2006-05-20 |
| 1669423950 | Suzanne S Hecht | Family Medicine | 2512 South 7th Street, First Floor, R102, University Orthopeadics, Minneapolis, MN 55454-1404 | 2006-05-12 |
| 1295231702 | Rachel Kwiatkowski | Family Medicine | 550 Osborne Rd Ne, Fridley, MN 55432-2718 | 2018-04-03 |
| 1255793261 | Arie Degrio | Family Medicine | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2016-03-28 |
| 1437525292 | Orthocure LLC | Family Medicine | 6636 Cedar Ave S Ste 170, Richfield, MN 55423-2710 | 2015-08-17 |
| 1871974022 | Mark Cipriani Jr. | Family Medicine | 200 1st St Sw, Rochester, MN 55905-0001 | 2015-06-13 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.