Individual provider Active NPI

Michael A. Olds, PA-C

  • Physician Assistant
  • Baltimore, MD
National Provider Identifier
1255532099
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C001355 Issued in MD
Practice address
1419 Knecht Ave
Baltimore, MD 21227-1415
Phone
(410) 247-9595
NPI assigned
May 30, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C001355 MD Primary

Addresses

Primary practice location

1419 Knecht Ave
Baltimore, MD 21227-1415

Mailing address

PO Box 9065
1748 Stengel Avvenue
Baltimore, MD 21222-0765
Phone (443) 562-3270

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20130223000066 MD Practitioner - Physician Assistant 9537233044 Reassigns benefits to 2 organizations
I20170807001108 DC Practitioner - Physician Assistant 9537233044 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MNR Industries, LLCGroup PAC ID 7416908843, 142 clinicians

Practice addresses (Care Compare)

1307 Merritt Blvd
Dundalk, MD 21222-2109
Phone (410) 288-2121

1470 Martin Blvd
Middle River, MD 21220-4105
Phone (443) 231-5203

1505 E Churchville Rd
Bel Air, MD 21014-4742

2006 Rock Spring Rd
Forest Hill, MD 21050-2607
Phone (410) 569-0044

4009 N Point Blvd
105 Expresscare of North Point
Dundalk, MD 21222-3619
Phone (410) 477-1039

5 Bel Air S Pkwy
Suite 1535
Bel Air, MD 21015-3816
Phone (410) 569-0044

7700 Belair Rd
Baltimore, MD 21236-4004
Phone (410) 665-0670

7701 Harford Rd
Parkville, MD 21234-6403
Phone (410) 569-0069

8000 Loch Raven Blvd
Loch Raven, MD 21286-8337
Phone (410) 616-9027

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C001355MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
MNR Industries, LLC CurrentSince Jun 10, 2017 Accepting new patients
MNR Industries LLC CurrentSince Jun 22, 2016 Accepting new patients
MNR Industries, LLC CurrentSince Jun 22, 2016 Accepting new patients
MNR Industries LLC Past Accepting new patients
Emergency Medicine Physician Partners of Riverside County, Inc Past Accepting new patients
Delmar Emergency Specialists PA Past Accepting new patients

Locations

1505 E Churchville Rd
Bel Air, MD 21014
Phone (410) 420-6970

1505 E Churchville Rd
#A
Bel Air, MD 21014
Phone (410) 420-6970

6000 Laurel Bowie Rd
Bowie, MD 20715
Phone (301) 383-0330

1470 Martin Blvd
Middle River, MD 21220
Phone (410) 686-4084

7700 Belair Rd
Nottingham, MD 21236
Phone (410) 665-0670

10490 Owings Mills Blvd
Owings Mills, MD 21117
Phone (410) 363-7281

Organizations & group practices 9

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255532099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9065",
            "address_2": "1748 STENGEL AVVENUE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212220765",
            "telephone_number": "443-562-3270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1419 KNECHT AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212271415",
            "telephone_number": "410-247-9595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLDS",
        "first_name": "MICHAEL",
        "middle_name": "A.",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C001355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.