Individual provider Active NPI

Olivia Paige Maddox, PA

  • Physician Assistant
  • Lebanon, NH
National Provider Identifier
1164145082
Registry record updated Nov 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1 Medical Center Dr
Lebanon, NH 03756-0001
Phone
(603) 650-5000
NPI assigned
Sep 26, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2023

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 2111 NH
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1 Medical Center Dr
Lebanon, NH 03756-0001

Mailing address

408 E 8TH St Apt 3
Boston, MA 02127-2957
Phone (612) 810-6643

Other practice location 1

360 Huntington Ave
Boston, MA 02115-5000
Phone (617) 373-3195

Other practice location 2

273 County Rd
New London, NH 03257-5736
Phone (603) 526-2911

Other names 1

  • Olivia Paige Rotenberg Former name

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
I20240216003369 NH Practitioner - Physician Assistant 3678917721 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dartmouth-Hitchcock ClinicGroup PAC ID 4183537509, 1,445 clinicians
Mary Hitchcock Memorial HospitalGroup PAC ID 4486561164, 1,269 clinicians

Practice addresses (Care Compare)

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

273 Country Rd
New London, NH 03257-5736
Phone (603) 526-5000

PO Box
Suite 810
Hanover, NH 03755-0810

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2111NHMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Dartmouth-Hitchcock Clinic CurrentSince Nov 13, 2023 Accepting new patients
Mary Hitchcock Memorial Hospital CurrentSince Nov 13, 2023 Accepting new patients
Dartmouth-Hitchcock Clinic CurrentSince Nov 13, 2023 Accepting new patients
The New London Hospital Association, Inc. CurrentSince Nov 13, 2023 Accepting new patients
Mary Hitchcock Memorial Hospital Past Accepting new patients
The New London Hospital Association, Inc. Past Accepting new patients

Locations

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

273 County Rd
New London, NH 03257
Phone (603) 526-5215

Interoperability endpoints

  • Direct secure messaging: omaddox508921@direct.dartmouth-hitchcock.org

Organizations & group practices 6

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 4

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": "1664150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699488000000",
    "number": "1164145082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 E 8TH ST APT 3",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021272957",
            "telephone_number": "612-810-6643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037560001",
            "telephone_number": "603-650-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "360 Huntington Ave",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021155000",
            "country_code": "US",
            "telephone_number": "617-373-3195",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "273 County Rd",
            "address_purpose": "LOCATION",
            "city": "New London",
            "state": "NH",
            "postal_code": "032575736",
            "country_code": "US",
            "telephone_number": "603-526-2911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MADDOX",
        "first_name": "OLIVIA",
        "middle_name": "PAIGE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-26",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "2111",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "OLIVIA",
            "last_name": "ROTENBERG",
            "middle_name": "PAIGE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lebanon, NH

Sources for this page

Verify at the official NPI Registry.