Active NPI
Mark Warren Olson, M.D.
- Family Medicine Physician
- Salem, OR
National Provider Identifier
1043392012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OR MD09591
- Practice address
- 1160 Wallace Rd NW
Salem, OR 97304-3116 - Phone
- (503) 361-5400
- Fax
- (503) 361-5401
- NPI assigned
- Oct 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OR MD09591 | OR | Primary |
Addresses
Primary practice location
1160 Wallace Rd NW
Salem, OR 97304-3116
Mailing address
8750 Oak Grove Rd
Rickreall, OR 97371-9766
Phone (503) 835-4001
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 23416-1 | Medicaid | OR |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq | Health Information Exchange (HIE) | Northwest Permanente PC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OR MD09591 | OR | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643932800000",
"number": "1043392012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8750 OAK GROVE RD",
"city": "RICKREALL",
"state": "OR",
"postal_code": "973719766",
"telephone_number": "503-835-4001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1160 WALLACE RD NW",
"city": "SALEM",
"state": "OR",
"postal_code": "973043116",
"telephone_number": "503-361-5400",
"fax_number": "503-361-5401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSON",
"first_name": "MARK",
"middle_name": "WARREN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2022-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "OR MD09591",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "23416-1",
"state": "OR"
}
],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
"affiliation": "Y",
"endpointDescription": "Carequality",
"affiliationName": "Northwest Permanente PC",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "1160 Wallace Rd NW",
"city": "Salem",
"state": "OR",
"country_code": "US",
"postal_code": "973043116",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.