Individual provider Active NPI

Susan Sheldon Olive, PA

  • Medical Physician Assistant
  • Houghton, NY
National Provider Identifier
1487291464
Registry record updated Sep 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
031795 Issued in NY
Practice address
9864 Luckey Dr
Houghton, NY 14744-8706
Phone
(716) 375-7500
NPI assigned
Dec 9, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 031795 NY Primary

Addresses

Primary practice location

9864 Luckey Dr
Houghton, NY 14744-8706

Mailing address

9864 Luckey Dr
Houghton, NY 14744-8706
Phone (716) 375-7500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, NY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200109000026 NM Practitioner - Physician Assistant 1951736594 Reassigns benefits to 1 organization
I20240530000702 NY Practitioner - Physician Assistant 1951736594 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

140 W Main St
Suite 1
Cuba, NY 14727-1317
Phone 71637575006879

9864 Luckey Dr
Houghton, NY 14744-8706
Phone 71637575006879

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Tier Community Health Center Network, Inc. CurrentSince May 21, 2024 Accepting new patients
Southern Tier Community Health Center Network, Inc. CurrentSince May 21, 2024 Accepting new patients
Presbyterian Medical Services CurrentSince Jan 13, 2020 Accepting new patients
Presbyterian Medical Services CurrentSince Jan 13, 2020 Accepting new patients

Locations

1422 Paseo de Peralta
Santa Fe, NM 87501
Phone (505) 982-5565

1775 Hopewell St
Santa Fe, NM 87505
Phone (505) 443-3100

140 W Main St
#1
Cuba, NY 14727

132 W Main St
Cuba, NY 14727

9864 Luckey Dr
Houghton, NY 14744

135 N Union St
Olean, NY 14760

500 Main St
Olean, NY 14760
Phone (716) 373-2600

Interoperability endpoints

  • Direct secure messaging: susan.olive@sthc.eclinicaldirectplus.com

Organizations & group practices 5

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 7

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": "1575849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757462400000",
    "number": "1487291464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9864 LUCKEY DR",
            "city": "HOUGHTON",
            "state": "NY",
            "postal_code": "147448706",
            "telephone_number": "716-375-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9864 LUCKEY DR",
            "city": "HOUGHTON",
            "state": "NY",
            "postal_code": "147448706",
            "telephone_number": "716-375-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVE",
        "first_name": "SUSAN",
        "middle_name": "SHELDON",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-09",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "031795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houghton, NY

Sources for this page

Verify at the official NPI Registry.