Individual provider Active NPI

Olivia Masterson

  • Physician Assistant
  • Davenport, IA
National Provider Identifier
1306572094
Registry record updated Jul 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1320 W Lombard St
Davenport, IA 52804-2029
Phone
(563) 333-5886
NPI assigned
Jul 26, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2022

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 Primary

Addresses

Primary practice location

1320 W Lombard St
Davenport, IA 52804-2029

Mailing address

1320 W Lombard St
Davenport, IA 52804-2029
Phone (563) 333-5886

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20240506003176 IA Practitioner - Physician Assistant 5395185409 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Genesis Health SystemGroup PAC ID 6103829338, 262 clinicians

Practice addresses (Care Compare)

4700 E 56TH St
Davenport, IA 52807-2904

Hospital & facility affiliations

  • Genesis Medical Center-Davenport Hospital, Davenport, IA, CCN 160033
  • Genesis HLTH System Dba Genesis MDL Ctr-Illini Hospital, Silvis, IL, CCN 140275
  • Mercyone Genesis Dewitt Medical Center Hospital, Dewitt, IA, CCN 161313
  • Trinity Rock Island Hospital, Rock Island, IL, CCN 140280
  • Trinity - Bettendorf Hospital, Bettendorf, IA, CCN 160104

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Health System CurrentSince May 6, 2024 Accepting new patients
Genesis Health System CurrentSince May 6, 2024 Accepting new patients

Locations

865 Lincoln Rd
Ste 100
Bettendorf, IA 52722
Phone (563) 355-1000

1351 W Central Park Ave
Ste 4100
Davenport, IA 52804
Phone (563) 355-9191

4700 E 56th St
Ste 100
Davenport, IA 52807
Phone (563) 383-2667

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 5

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": "1658793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658793600000",
    "number": "1306572094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 W LOMBARD ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528042029",
            "telephone_number": "563-333-5886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 W LOMBARD ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528042029",
            "telephone_number": "563-333-5886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASTERSON",
        "first_name": "OLIVIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-26",
        "last_updated": "2022-07-26",
        "certification_date": "2022-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.