Samuel Jordan Olson, D.O.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

E-11906 Issued in AR

Practice address

4301 W Markham St # 589
Little Rock, AR 72205-7101

Phone

(501) 526-8148

NPI assigned

Mar 31, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

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

Specialty

PsychiatryAlso: Osteopathic Manipulative Medicine

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

State of ArkansasGroup PAC ID 6507863958, 18 clinicians

Centers for Youth and Families IncGroup PAC ID 4486996279, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Centers for Youth and Families, Inc.

  • Psychiatric Residential Treatment Facility
  • Little Rock, AR
  • NPI 1174617526
  Medicare reassignment Care Compare group NPD
• State of Arkansas

  • Psychiatric Hospital
  • Little Rock, AR
  • NPI 1891808630
  Medicare reassignment Care Compare group NPD
• State of Arkansas

  • Skilled Nursing Facility
  • North Little Rock, AR
  • NPI 1689117756
  NPD

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

{
    "created_epoch": "1490918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570406400000",
    "number": "1366974008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 W MARKHAM ST # 589",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722057101",
            "telephone_number": "501-526-8148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 W MARKHAM ST # 589",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722057101",
            "telephone_number": "501-526-8148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "SAMUEL",
        "middle_name": "JORDAN",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-31",
        "last_updated": "2019-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AR",
            "license": "E-11906",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer B Olivier, DNP, APRN, A-GNP-C
• Yolanda Dionne Ollison
• Sarah Olney, PT
• Lisa Kay Olsen, MS,CCC-SLP
• Leah Olson
• Meredith K Olsson, LMFT
• Jayson M Olvera, CPHT
• Rahaf Salem Fouad Omaish, MD
• Omega Family Dental
• Chioma Omeniho

• Psychiatry Physician in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Psychiatry Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2019; 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.
• 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.