Organization Active NPI

Jay E. Olsson, D.O., P.a.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Melbourne, FL
National Provider Identifier
1366463226
Registry record updated Apr 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
OS0004087 Issued in FL
Legal business name
JAY E. OLSSON, D.O., P.A.
Practice address
401 N Wickham Rd
Suite S
Melbourne, FL 32935-8659
Phone
(321) 242-9031
Fax
(321) 242-9035
NPI assigned
Jul 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2015

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

Authorized official

Name
Jay Edward Olsson, D.O.
Title
Medical Director
Phone
(321) 242-9031

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2081P2900X OS0004087 FL Primary

Addresses

Primary practice location

401 N Wickham Rd
Suite S
Melbourne, FL 32935-8659

Mailing address

401 N Wickham Rd
Suite S
Melbourne, FL 32935-8659
Phone (321) 242-9031

Other identifiers 1

IdentifierTypeStateIssuer
K5335OtherFLMEDICARE ID

National Provider Directory

National Provider Directory

Locations

401 N Wickham Rd
Ste N
Melbourne, FL 32935
Phone (321) 242-9031

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428537600000",
    "number": "1366463226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 N WICKHAM RD",
            "address_2": "SUITE S",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329358659",
            "telephone_number": "321-242-9031",
            "fax_number": "321-242-9035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N WICKHAM RD",
            "address_2": "SUITE S",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329358659",
            "telephone_number": "321-242-9031",
            "fax_number": "321-242-9035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAY E. OLSSON, D.O., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "last_updated": "2015-04-09",
        "status": "A",
        "authorized_official_last_name": "OLSSON",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "321-242-9031",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "FL",
            "license": "OS0004087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "K5335",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.