Individual provider Active NPI

Olivia Mary McLean, PA-C

  • Physician Assistant
  • Keene, NH
National Provider Identifier
1154165819
Registry record updated Aug 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2860 Issued in NH
Practice address
580 Court St
Keene, NH 03431-1718
Phone
(603) 354-5400
NPI assigned
Jun 19, 2024
Last updated
Aug 30, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Physician Assistant 363A00000X 2860 NH Primary

Addresses

Primary practice location

580 Court St
Keene, NH 03431-1718

Mailing address

580 Court St
Keene, NH 03431-1718
Phone (603) 354-5400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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 1

Enrollment IDStateProvider typePAC IDDetails
I20240920003409 NH Practitioner - Physician Assistant 7315488095 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dartmouth-Hitchcock ClinicGroup PAC ID 4183537509, 1,445 clinicians

Practice addresses (Care Compare)

1 Medical Ctr Dr
Lebanon, NH 03756-1000
Phone (603) 650-5000

580 Court St
Keene, NH 03431-1718
Phone (603) 354-5400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2860NHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mary Hitchcock Memorial Hospital CurrentSince Sep 16, 2024 Accepting new patients
Dartmouth-Hitchcock Clinic CurrentSince Sep 16, 2024 Accepting new patients
Cheshire Medical Center CurrentSince Sep 16, 2024 Accepting new patients
Dartmouth-Hitchcock Clinic CurrentSince Sep 16, 2024 Accepting new patients

Locations

580 Court St
Keene, NH 03431
Phone (603) 354-5454

1 Medical Dr
Lebanon, NH 03756
Phone (603) 650-5922

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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": "1718755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1154165819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 COURT ST",
            "city": "KEENE",
            "state": "NH",
            "postal_code": "034311718",
            "telephone_number": "603-354-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 COURT ST",
            "city": "KEENE",
            "state": "NH",
            "postal_code": "034311718",
            "telephone_number": "603-354-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCLEAN",
        "first_name": "OLIVIA",
        "middle_name": "MARY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-19",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "2860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Keene, NH

Sources for this page

Verify at the official NPI Registry.