Olive Tree Wellness Center, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A8409 Issued in CA

Legal business name

OLIVE TREE WELLNESS CENTER, INC

Practice address

1146 Olivewood Dr
Merced, CA 95348-1210

Phone

(209) 723-0019

Fax

(415) 946-3489

NPI assigned

Jun 29, 2008

Last updated

Apr 2, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Pamela Roussos, DONPI 1275612038

Title

Owner

Phone

(209) 723-0019

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Pamela Roussos, DO

  • Family Medicine Physician
  • Merced, CA
  • NPI 1275612038
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1214697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333324800000",
    "number": "1295997419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2718",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953440718",
            "telephone_number": "209-723-0019",
            "fax_number": "415-946-3489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1146 OLIVEWOOD DR",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953481210",
            "telephone_number": "209-723-0019",
            "fax_number": "415-946-3489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVE TREE WELLNESS CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-29",
        "last_updated": "2012-04-02",
        "status": "A",
        "authorized_official_last_name": "ROUSSOS",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-723-0019",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A8409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tony M. Ohn, M.D.
• Julianah Adenike Olabode, FNP
• Maribel Olea
• Wendy Olguin
• Hugo Olivarez
• Paula Vanessa Olivera
• Olivewood Meadows Chiropractic
• Desiree Ann Ople, ACSW
• Optimum Physical Therapy, P.C.
• Alyssa Marie Orellana

• Family Medicine Physician in Merced, CA
• Providers in Merced, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.