Randy Shane Olli, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301060059 Issued in MI

Practice address

325 E H St
Iron Mountain, MI 49801-4760

Phone

(906) 774-3300

NPI assigned

Jul 8, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Schoolcraft Memorial Hospital

  • Critical Access Hospital
  • Manistique, MI
  • NPI 1700805157
  Medicare reassignment NPD
• Baraga County Memorial Hospital

  • Emergency Medicine Physician
  • Lanse, MI
  • NPI 1508960600
  NPD
• Baraga County Memorial Hospital

  • Family Medicine Physician
  • Lanse, MI
  • NPI 1851409643
  NPD

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599436800000",
    "number": "1366475931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 E H ST",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498014760",
            "telephone_number": "906-774-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 E H ST",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498014760",
            "telephone_number": "906-774-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLLI",
        "first_name": "RANDY",
        "middle_name": "SHANE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-08",
        "last_updated": "2020-09-07",
        "certification_date": "2020-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301060059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RHC BC NUMBER",
            "identifier": "0G71004",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "0G76001",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anthony J Occhietti, DDS
• Maria Occhietti, MD
• Michael J Occhietti, MD
• Selena Theresa Okler, RN
• Janelle Marie Olkkonen
• Karen Ann Olson, PH.D.
• Kristi Rae Olson, M.D.
• Anna Beth Painter, RRT
• Elizabeth Esther Paling, N.P.
• Kelly Palmquist, LLMSW

• Family Medicine Physician in Iron Mountain, MI
• Providers in Iron Mountain, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.