ODOM SPORTS MEDICINE, P.A. (NPI# 1275557886) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275557886 |
| Entity Type | Organization |
| Organization Name | ODOM SPORTS MEDICINE, P.A. |
| Other Organization Name | ODOM HEALTH & WELLNESS |
| Practice Address |
10653 Wayzata Blvd Ste 200 Minnetonka MN 55305-1543 |
| Practice Telephone | 9522241919 |
| Mailing Telephone | 9522241919 |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-07-13 |
| Authorized Official Name | DR. JOHN H ODOM JR. (PRESIDENT) |
| Authorized Official Telephone | 9522241919 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Odom Health & Wellness | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 10500 Wayzata Blvd, Minnetonka, MN 553051511 | 9525452225 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740625870 | Odom Sports Medicine, P.a. | Physical Therapist | 500 S Cherry St, Waconia, MN 55387-4515 | 2013-05-02 |
| Street Address |
10653 WAYZATA BLVD STE 200 |
| City | MINNETONKA |
| State | MN |
| Zip Code | 55305-1543 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487145405 | Andrew Moran | Physical Therapist | 10653 Wayzata Blvd Ste 200, Minnetonka, MN 55305-1543 | 2018-05-24 |
| 1528457868 | Rejuva Medical and Wellness Center L.l.c | Chiropractor | 10653 Wayzata Blvd Ste 200, Minnetonka, MN 55305-1543 | 2015-01-09 |
| 1568863405 | Pw Clinic Pllc | Chiropractor | 10653 Wayzata Blvd Ste 200, Minnetonka, MN 55305-1543 | 2014-09-10 |
| 1750660189 | Ann-marie Elin Chesterfield | Physical Therapist | 10653 Wayzata Blvd Ste 200, Minnetonka, MN 55305-1543 | 2011-08-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255948584 | Sober Living Connection | Substance Abuse Rehabilitation Facility | 11115 Minnetonka Blvd, Hopkins, MN 55305 | 2020-09-30 |
| 1649739103 | Gabriel Douglas Orem | Occupational Therapist | 10653 Waysata Blvd., Suite 200, Minnetonka, MN 55305 | 2019-03-14 |
| 1750863106 | Andrea Haglin | Counselor | 10505 Wayzata Blvd. Ste 101, Minnetonka, MN 55305 | 2018-09-02 |
| 1770934499 | Acme Transportation | Private Vehicle | 11356 Cedar Pointe Dr, Minnetonka, MN 55305 | 2016-06-23 |
| 1841641743 | Laine Cecily Hartwell Epp | Counselor | 1300 Wayzata Blvd., Ste. 400, Minnetonka, MN 55305 | 2016-06-22 |
| 1407217367 | Larissa Vados | Acupuncturist | 11654 Wayzata Blvd, Minnetonka, MN 55305 | 2016-03-18 |
| 1548658982 | Irene Grudsky | Contractor | 10550 Wayzata Blvd, Minnetonka, MN 55305 | 2015-01-08 |
| 1780093500 | Lalaine Arbuthnot Ortlieb | Counselor | 11900 Wayzata Blvd, Suite 100, Minnetonka, MN 55305 | 2014-08-06 |
| 1235472275 | Katherine Thistle Rivard | Dietitian, Registered | 11240 Cedar Pointe Drive North, Minnetonka, MN 55305 | 2013-03-28 |
| 1558633784 | Vickie Lynn Schaefer | Social Worker | 10505 Wayzata Blve Suite 101, Minnetonka, MN 55305 | 2012-02-03 |
| Find all providers in zip 55305 | ||||
| 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 |
|---|---|---|---|---|
| 1306163571 | Maria Christine Ryan | Family Medicine | 15450 Highway 7 Ste 125, Minnetonka, MN 55345-3522 | 2010-04-28 |
| 1720252299 | Jacob P. Hayman | Family Medicine | 15111 Twelve Oaks Center Dr, Carlson Clinic, Minnetonka, MN 55305-5201 | 2008-04-16 |
| 1588601603 | Richard Charles Reut | Family Medicine | 2000 Plymouth Rd, Ridgehill Professional Build Ste 110, Minnetonka, MN 55305-2366 | 2006-05-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316239361 | David Ian Smith | Family Medicine | 516 15th Ave Se Ste 190e, Minneapolis, MN 55455-0130 | 2011-05-10 |
| 1659437267 | Peter Swann | Family Medicine | 1400 Corporate Center Curv Ste 200, Eagan, MN 55121-1372 | 2006-12-28 |
| 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 |
| 1144617366 | Mckayla Schmitt | Family Medicine | 8100 Northland Dr, Bloomington, MN 55431-4800 | 2015-04-26 |
| 1497157168 | Univeristy of Minnesota Duluth | Family Medicine | 1216 Ordean Ct, Duluth, MN 55812-3032 | 2014-09-24 |
| Find all providers with the same taxonomy | ||||
| City | MINNETONKA |
| Zip Code | 55305 |
Please comment or provide details below to improve the information on ODOM SPORTS MEDICINE, P.A..
| 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.