Amanda S Olsen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3281-23 Issued in WI

Practice address

2200 Dickinson Rd Unit 17B
De Pere, WI 54115-4070

Phone

(920) 965-1234

Fax

(920) 965-1232

NPI assigned

Mar 2, 2011

Last updated

Apr 10, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Amanda S. Wolf Former name

Medicare fee-for-service enrollment

Enrolled in WI

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

Specialty

Physician Assistant

Education

Yale University School of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wisconsin Institute of Plastic Surgery SCGroup PAC ID 3678574662, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wisconsin Institute of Plastic Surgery SC

  dba Wisconsin Oculoplastics SC

  • Plastic Surgery Physician
  • Appleton, WI
  • NPI 1487703880
  Medicare reassignment Care Compare group
• Fox Valley Plastic Surgery, S.C.

  • Plastic Surgery Physician
  • Oshkosh, WI
  • NPI 1669695284
  NPD (past)
• Fox Valley Urological Associates SC

  • Urology Physician
  • Appleton, WI
  • NPI 1356601587
  NPD (past)
• Memorial Hospital Inc

  dba Marshfield Medical Center - Neillsville Clinic

  • Rural Health Clinic/Center
  • Neillsville, WI
  • NPI 1619966793
  NPD (past)

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

{
    "created_epoch": "1299024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681084800000",
    "number": "1407154354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 DICKINSON RD UNIT 17B",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541154070",
            "telephone_number": "920-965-1234",
            "fax_number": "920-965-1232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 DICKINSON RD UNIT 17B",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541154070",
            "telephone_number": "920-965-1234",
            "fax_number": "920-965-1232"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2700 E Enterprise Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549137656",
            "country_code": "US",
            "telephone_number": "920-965-1234",
            "fax_number": "920-965-1232",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLSEN",
        "first_name": "AMANDA",
        "middle_name": "S",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-02",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA4138",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "3281-23",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3281-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN PA LICENSE",
            "identifier": "3281-23",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100037410",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "PA4138",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "WOLF",
            "middle_name": "S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Steven John Novotny, MD
• Erin C Nuthals, RN, BSN
• Stephanie O'Connor, LCSW
• Odyssey Healthcare Holding Company (Heartland Hospice (Green Bay))
• Maureen Oldenburg
• Hannah Miriam Olson, MD
• Jacob Scott Ommen
• Optum Behavioral Care of Colorado, P.C.
• Optum Behavioral Care of Colorado, P.C.
• Heather Orlando

• Physician Assistant in De Pere, WI
• Providers in De Pere, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; 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.