Active NPI
Juan C Olazagasti, MD
- Pediatric Gastroenterology Physician
- Roanoke, VA
National Provider Identifier
1154430916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Gastroenterology Physician
- License
- 0101240810
- Practice address
- 4348 Electric Rd
Roanoke, VA 24018-0720 - Phone
- (540) 769-0976
- Fax
- (540) 857-5391
- NPI assigned
- Aug 29, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Gastroenterology Physician | 2080P0206X | ME0057738 | FL | |
| Pediatric Gastroenterology Physician | 2080P0206X | 0101240810 | VA | Primary |
Addresses
Primary practice location
4348 Electric Rd
Roanoke, VA 24018-0720
Mailing address
213 S Jefferson St Ste 1006
Roanoke, VA 24011-1713
Phone (540) 224-5715
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010344701 | Medicaid | VA | |
| 010383731 | Medicaid | VA | |
| 55285201 | Medicaid | FL |
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME0057738 | FL | MD | Pediatric Gastroenterology Physician |
Interoperability endpoints
- jolazagasti11269@direct.carilionclinic.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660003200000",
"number": "1154430916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "213 S JEFFERSON ST STE 1006",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240111713",
"telephone_number": "540-224-5715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4348 ELECTRIC RD",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240180720",
"telephone_number": "540-769-0976",
"fax_number": "540-857-5391"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLAZAGASTI",
"first_name": "JUAN",
"middle_name": "C",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-29",
"last_updated": "2022-08-09",
"certification_date": "2022-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0206X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Gastroenterology",
"state": "FL",
"license": "ME0057738",
"primary": false
},
{
"code": "2080P0206X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Gastroenterology",
"state": "VA",
"license": "0101240810",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "010344701",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "010383731",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "55285201",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Roanoke, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 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.