Individual provider Active NPI

Andrea Jean Marie Olson, M.D.

  • Anesthesiology Physician
  • Roanoke, VA
National Provider Identifier
1164657151
Registry record updated Mar 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
0101253911 Issued in VA
Practice address
5115 Bernard Dr Ste 201
Roanoke, VA 24018-4367
Phone
(540) 345-0289
Fax
(540) 345-9569
NPI assigned
May 20, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 0101253911 VA Primary

Addresses

Primary practice location

5115 Bernard Dr Ste 201
Roanoke, VA 24018-4367

Mailing address

PO Box 13306
Roanoke, VA 24032-3306
Phone (540) 345-0289

Other identifiers 2

IdentifierTypeStateIssuer
1164657151MedicaidVA
1164657151MedicaidWV

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130802000205 VA Practitioner - Anesthesiology 3779724703 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Michigan State University College of Human Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acv IncGroup PAC ID 3870633936, 70 clinicians

Practice addresses (Care Compare)

1722 S Jefferson St
Roanoke, VA 24014-2482
Phone (540) 981-7268

Hospital & facility affiliations

  • Carilion Medical Center Hospital, Roanoke, VA, CCN 490024

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Acv Inc Anesthesiology CurrentSince Aug 1, 2013 Accepting new patients
Anesthesiology Consultants of Virginia, Inc Anesthesiology PastSince Aug 1, 2013 Accepting new patients

Locations

5115 Bernard Dr
Ste 201
Roanoke, VA 24018
Phone (540) 345-0289

1102 S Jefferson St
Roanoke, VA 24016
Phone (540) 342-0707

1906 Belleview Ave SE
Roanoke, VA 24014
Phone (540) 853-0222

Organizations & group practices 2

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 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": "1242777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583366400000",
    "number": "1164657151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13306",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240323306",
            "telephone_number": "540-345-0289",
            "fax_number": "540-345-9569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5115 BERNARD DR STE 201",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240184367",
            "telephone_number": "540-345-0289",
            "fax_number": "540-345-9569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "ANDREA",
        "middle_name": "JEAN MARIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-20",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VA",
            "license": "0101253911",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164657151",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164657151",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.