Active NPI
Eric Olson, PA
- Physician Assistant
- Show Low, AZ
National Provider Identifier
1083677876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2263
- Practice address
- 2450 E Show Low Lake Rd Ste 1
Show Low, AZ 85901-7953 - Phone
- (928) 532-5577
- NPI assigned
- Apr 11, 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2263 | AZ | Primary |
Addresses
Primary practice location
2450 E Show Low Lake Rd Ste 1
Show Low, AZ 85901-7953
Mailing address
2588 S Forest Meadow LN
Pinetop, AZ 85935-5016
Phone (928) 528-7523
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 578385 | Medicaid | AZ | |
| S6576 | Medicaid | NM |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2263 | AZ | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539907200000",
"number": "1083677876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2588 S FOREST MEADOW LN",
"city": "PINETOP",
"state": "AZ",
"postal_code": "859355016",
"telephone_number": "928-528-7523",
"fax_number": "928-532-1969"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2450 E SHOW LOW LAKE RD STE 1",
"city": "SHOW LOW",
"state": "AZ",
"postal_code": "859017953",
"telephone_number": "928-532-5577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSON",
"first_name": "ERIC",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-11",
"last_updated": "2018-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AZ",
"license": "2263",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "578385",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "S6576",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Show Low, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.