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NKENNA ODOM MD
NPI 1972098465
Family Medicine in Providence, RI

Active since June 27, 2018PECOS EnrolledAccepts Medicare Assignment
1195 NORTH MAIN STREET, CNEMG PRIMARY CARE WMC, PROVIDENCE, RI 02904(401) 736-4562(401) 921-9864 Get Directions Write a Review

NPPES record last updated: February 19, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Feb 19, 2025, Feb 12, 2025, Nov 18, 2024 and 2 more (5 updates tracked since 2018).

About Nkenna Odom Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NKENNA ODOM MD (NPI 1972098465) is an individual family medicine provider in Providence, Rhode Island, licensed in Rhode Island (MD17589) and active in the NPI registry since June 2018. She is enrolled in Medicare PECOS, is affiliated with Rhode Island Hospital, and is a graduate of Other (2018).

NPPES Registry Identity

NPI1972098465
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NameNKENNA ODOMCredential: MD
Location Address1195 NORTH MAIN STREET, CNEMG PRIMARY CARE WMCProvidence, RI 02904-0288
Mailing Address455 Toll Gate Rd, Prc And CredentialingWarwick, RI 02886-2759 · (401) 273-0641 · Fax (401) 273-2919
Phone(401) 736-4562
Fax(401) 921-9864
Sole ProprietorNo
Medical School CMSOtherGraduated 2018
Enumeration DateJune 27, 2018
Last NPPES UpdateFebruary 19, 20255 updates tracked since enumeration
NPPES CertifiedFebruary 14, 2025
✔ NPI 1972098465 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in RI · MD17589
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
1195 NORTH MAIN STREET, Providence, RI 02904
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Nkenna Odom Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1153723119
PECOS Enrollment IDI20210713002742
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Nkenna Odom reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

The Miriam Hospital
1.0 mi
Multi-Specialty
146 W RIVER ST
Providence, RI 02904
  • Reassigned Medicare billing, Rhode Island enrollment
  • 53 clinicians in this Medicare group
NPI 1164716031 (401) 793-3215
Affinity Physicians LLC
2.9 mi
Anesthesiology
101 DUDLEY STREET, WIH DEPT OF ANESTHESIOLOGY
Providence, RI 02905
  • Reassigned Medicare billing, Rhode Island enrollment
  • 984 clinicians in this Medicare group
NPI 1053038471 (401) 274-1122

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
91 services54 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
25 services25 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
11 services11 patients

Hospital Affiliations CMS Care Compare 4

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Rhode Island Hospital

Acute Care Hospitals · Providence, RI
3/5 CMS rating
OwnershipTribal
CMS Certification Number410007
Location593 Eddy StreetProvidence, RI 02903 · Providence County
Emergency services

Kent County Memorial Hospital

Acute Care Hospitals · Warwick, RI
3/5 CMS rating
OwnershipProprietary
CMS Certification Number410009
Location455 Toll Gate RdWarwick, RI 02886 · Kent County
Emergency services Birthing friendly

Women & Infants Hospital Of Rhode Island

Acute Care Hospitals · Providence, RI
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number410010
Location101 Dudley StreetProvidence, RI 02905 · Providence County
Emergency services Birthing friendly

The Miriam Hospital

Acute Care Hospitals · Providence, RI
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number410012
Location164 Summit AvenueProvidence, RI 02906 · Providence County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 02904 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$90.48 typical visit price
range $58.57 – $177.03
Typical copayment $22.62 (range $14.64 – $44.25)
Most-billed visit code 99203
Established Patient
$103.10 typical visit price
range $18.92 – $144.38
Typical copayment $25.77 (range $4.73 – $36.09)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

IRIS L TONG MD
Internal Medicine
1195 NORTH MAIN STREET, CNEMG PRIMARY CARE WMC
PROVIDENCE, RI 02904
Providence County (401) 736-4562
KATHY ANN REBEIRO APRN-CNP
Nurse Practitioner (Adult Health)
1195 NORTH MAIN STREET, CNEMG PRIMARY CARE WMC
PROVIDENCE, RI 02904
Providence County (401) 736-4562
MOLLY ANN FOX PA-C
Physician Assistant (Medical)
1195 NORTH MAIN STREET, CNEMG PRIMARY CARE WMC
PROVIDENCE, RI 02904
Providence County (401) 736-4562
RACHEL JOHANSON CNM, WHNP, FNP
Nurse Practitioner (Family)
1195 NORTH MAIN STREET, CNEMG PRIMARY CARE WMC
PROVIDENCE, RI 02904
Providence County (401) 736-4562
NANCY C LASSON D.O.
Internal Medicine
1195 NORTH MAIN STREET, CNEMG PRIMARY CARE WMC
PROVIDENCE, RI 02904
Providence County (401) 736-4562
DR. AMELIA VERA TAJIK MD
Internal Medicine
1195 NORTH MAIN STREET, CNEMG PRIMARY CARE WMC
PROVIDENCE, RI 02904
Providence County (401) 736-4562

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nkenna Odom's NPI number?

The NPI number for Nkenna Odom is 1972098465. It was assigned to this individual provider in the NPPES registry on June 27, 2018.

Where is Nkenna Odom located?

Nkenna Odom practices at 1195 North Main Street Cnemg Primary Care Wmc, Providence, RI 02904. The listed phone number is (401) 736-4562.

What is Nkenna Odom's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Nkenna Odom enrolled in Medicare?

Yes. Nkenna Odom is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Nkenna Odom's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nkenna Odom reassigns Medicare benefits to 2 organizations: The Miriam Hospital (Providence, RI) and Affinity Physicians LLC (Providence, RI). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Nkenna Odom's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Nkenna Odom affiliated with any hospitals?

According to CMS data, Nkenna Odom is affiliated with Rhode Island Hospital, Kent County Memorial Hospital, Women & Infants Hospital Of Rhode Island and The Miriam Hospital.

When was this NPI record last updated?

The NPPES record for Nkenna Odom was last updated on February 19, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.