Active NPI
Mark A Olson, M.D.
- Neurology Physician
- Warren, MI
National Provider Identifier
1225020746
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 4301044866
- Practice address
- 11012 E 13 Mile Rd
Suite 112
Warren, MI 48093-2572 - Phone
- (586) 573-6880
- Fax
- (586) 573-2562
- NPI assigned
- Aug 19, 2005
- Last updated
- Nov 8, 2013
- 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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 4301044866 | MI | Primary |
Addresses
Primary practice location
11012 E 13 Mile Rd
Suite 112
Warren, MI 48093-2572
Mailing address
29900 Lorraine Ave
Suite 400
Warren, MI 48093-5266
Phone (586) 582-0864
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1997933 | Medicaid | MI | |
| 700E021830 | Other | MI | BCBS |
| 700F340300 | Other | MI | BCBS |
| MO044866 | Other | MI | BCBS PIN # |
| 700E021910 | Other | MI | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383868800000",
"number": "1225020746",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29900 LORRAINE AVE",
"address_2": "SUITE 400",
"city": "WARREN",
"state": "MI",
"postal_code": "480935266",
"telephone_number": "586-582-0864",
"fax_number": "586-582-0964"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11012 E 13 MILE RD",
"address_2": "SUITE 112",
"city": "WARREN",
"state": "MI",
"postal_code": "480932572",
"telephone_number": "586-573-6880",
"fax_number": "586-573-2562"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSON",
"first_name": "MARK",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-19",
"last_updated": "2013-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MI",
"license": "4301044866",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1997933",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "700E021830",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "700F340300",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PIN #",
"identifier": "MO044866",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "700E021910",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Warren, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.