NPIMap

Individual provider Active NPI

Brian Patrick Olofsson, MD

  • Family Medicine Physician
  • Kankakee, IL
National Provider Identifier
1073604534
Registry record updated Dec 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036067325 Issued in IL
Practice address
400 N Wall
Suite 510
Kankakee, IL 60901
Phone
(815) 932-5725
Fax
(815) 932-5872
NPI assigned
Sep 27, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036067325 IL Primary

Addresses

Primary practice location

400 N Wall
Suite 510
Kankakee, IL 60901

Mailing address

400 N Wall
Suite 510
Kankakee, IL 60901
Phone (815) 932-5725

Other identifiers 1

IdentifierTypeStateIssuer
036067325MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071226000468 IL Practitioner - Family PracticePractitioner - Sleep Medicine 5395835656 Receives reassigned benefits from 1 practitioner
Practice locations: Kankakee, IL; Bradley, IL

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sleep Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

350 N Wall
Kankakee, IL 60901-2901
Phone (815) 933-1671

400 N Wall St
Suite 510
Kankakee, IL 60901-2965
Phone (815) 932-5725

500 W Court St
Provena St Marys Hospital
Kankakee, IL 60901-3661
Phone (815) 937-2490

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions289
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Brian Olofsson MD, LLC Family Medicine Current Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

400 N Wall St
Ste 510
Kankakee, IL 60901
Phone (815) 932-5725

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Organizations & group practices 3

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

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417651200000",
    "number": "1073604534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N WALL",
            "address_2": "SUITE 510",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "60901",
            "telephone_number": "815-932-5725",
            "fax_number": "815-932-5872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N WALL",
            "address_2": "SUITE 510",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "60901",
            "telephone_number": "815-932-5725",
            "fax_number": "815-932-5872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLOFSSON",
        "first_name": "BRIAN",
        "middle_name": "PATRICK",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2014-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036067325",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036067325",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kankakee, IL

Sources for this page

Verify at the official NPI Registry.