Odyssey Family Practice
NPI 1780142042ActiveOrganization· Family Medicine· Kenai, AK
Family Medicine in Kenai, Alaska, registered in NPPES in March 2019. The authorized official on file is Jared Lee Wallace, PA-C, Owner. Enrolled in Medicare as part b supplier - clinic/group practice and part b supplier - independent clinical laboratory.
Overview
| NPI | 1780142042 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Mar 6, 2019 |
| Last updated in NPPES | Dec 1, 2025 |
| Certified by provider | Dec 1, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine Primary | 207Q00000X | — | — |
| Clinic/Center, Occupational Medicine | 261QX0100X | — | — |
| Clinical Medical Laboratory | 291U00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (AK); Part B Supplier - Independent Clinical Laboratory (TX) |
|---|
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