NPIMap

Individual provider Active NPI

Jennifer Lea Olson, MD

  • Family Medicine Physician
  • Brookings, SD
National Provider Identifier
1285623439
Registry record updated Feb 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5937 Issued in SD
Practice address
922 22ND Ave S
Brookings, SD 57006-2830
Phone
(605) 697-1900
Fax
(605) 697-1919
NPI assigned
Oct 20, 2005
Last updated
Feb 15, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5937 SD Primary
Family Medicine Physician 207Q00000X 5215 AK

Addresses

Primary practice location

922 22ND Ave S
Brookings, SD 57006-2830

Mailing address

922 22ND Ave S
Brookings, SD 57006-2830
Phone (605) 697-1900

Other identifiers 1

IdentifierTypeStateIssuer
1285623439OtherSDNPI

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070226000300 SD Practitioner - Family Practice 7810945243 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Prairie View Medical Prof LLCGroup PAC ID 4183063050, 2 clinicians

Practice addresses (Care Compare)

3405 6TH St
Suite 5
Brookings, SD 57006-4401
Phone (605) 693-7862

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.71 of 100Reported as group
Quality
85.75
Improvement activities
40
Cost
78.48

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5215AKMDFamily Medicine Physician
5937SDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prairie View Medical, Prof. LLC CurrentSince Dec 18, 2023 Accepting new patients
Family Wellness Clinic PC CurrentSince Oct 1, 2021 Accepting new patients
Tanana Chiefs Conference Past Accepting new patients

Locations

216 W 2nd St S
Brookings, SD 57006
Phone (605) 627-1105

317 6th Ave
Brookings, SD 57006
Phone (605) 350-7212

3405 6th St
Ste 5
Brookings, SD 57006
Phone (605) 693-7862

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22632/brand/1/csg/1/fhir/r4
  • Direct secure messaging: jennifer.olson.1@30680.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 27

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613347200000",
    "number": "1285623439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "922 22ND AVE S",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062830",
            "telephone_number": "605-697-1900",
            "fax_number": "605-697-1919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "922 22ND AVE S",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062830",
            "telephone_number": "605-697-1900",
            "fax_number": "605-697-1919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "JENNIFER",
        "middle_name": "LEA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-20",
        "last_updated": "2021-02-15",
        "certification_date": "2021-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "5937",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "5215",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1285623439",
            "state": "SD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Brookings, SD

Sources for this page

Verify at the official NPI Registry.