Ray Brock Olson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2245 N 400 E
Ste 301
North Logan, UT 84341-1892

Phone

(435) 753-7880

Fax

(435) 359-4507

NPI assigned

May 20, 2019

Last updated

Jun 24, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in UT, ID2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cache Valley Ear Nose and Throat, PLLCGroup PAC ID 5193128882, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Health Logan Regional Hospital Hospital, Logan, UT, CCN 460015
• Cache Valley Hospital Hospital, North Logan, UT, CCN 460054

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cache Valley Ear Nose & Throat, PLLC

  dba Cache Valley Ear Nose and Throat.

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • North Logan, UT
  • NPI 1548303795

  ID

  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ihc Health Services Inc

  dba Intermountain Health Logan Regional Hospital

  • General Acute Care Hospital
  • Logan, UT
  • NPI 1831108497
  Care Compare affiliation
• Mountain Division - CVH, LLC

  dba Cache Valley Hospital

  • General Acute Care Hospital
  • North Logan, UT
  • NPI 1952703472
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656028800000",
    "number": "1033776562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2245 N 400 E",
            "address_2": "STE 301",
            "city": "NORTH LOGAN",
            "state": "UT",
            "postal_code": "843411892",
            "telephone_number": "435-753-7880",
            "fax_number": "435-359-4507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2245 N 400 E",
            "address_2": "STE 301",
            "city": "NORTH LOGAN",
            "state": "UT",
            "postal_code": "843411892",
            "telephone_number": "435-753-7880",
            "fax_number": "435-359-4507"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "736 Irving Ave",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132101690",
            "country_code": "US",
            "telephone_number": "315-470-7411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLSON",
        "first_name": "RAY",
        "middle_name": "BROCK",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-20",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1548303795",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shane Mozingo
• Michael Craig Mumford, DPT
• Josh Robert Novak, LMFT
• Erin Bagley Oberg, PA-C
• Heather Elizabeth Olsen, LCSW
• Eric Parker
• Ronald J Payne, M.O.
• Peak Health LLC (Peak Health)
• Sven Lee Peery, DMD
• Pelvic Clarity Physical Therapy LLC

• Physician Assistant in North Logan, UT
• Providers in North Logan, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.