Individual provider Active NPI

Emma Crill Olson, PA-C

  • Physician Assistant
  • Concord, NC
National Provider Identifier
1497294854
Registry record updated Jan 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-07235 Issued in NC
Practice address
920 Church St N
Concord, NC 28025-2927
Phone
(919) 274-2558
NPI assigned
Feb 18, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Physician Assistant 363A00000X 0010-07235 NC Primary

Addresses

Primary practice location

920 Church St N
Concord, NC 28025-2927

Mailing address

828 Seneca PL
Charlotte, NC 28210-2924
Phone (919) 274-2558

Other practice location 1

111 LeBlanc Ct
Cary, NC 27513-3542
Phone (919) 274-2558

Other practice location 2

288 S Ridgecrest Ave
Rutherfordton, NC 28139-2838
Phone (828) 286-5000

Other identifiers 2

IdentifierTypeStateIssuer
1142669OtherNCCPA CERTIFICATION
0010-07235OtherNCNORTH CAROLINA MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20170717000631 NC Practitioner - Physician Assistant 7810267317 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolina Medicorp Enterprises LLCGroup PAC ID 0648174904, 184 clinicians

Practice addresses (Care Compare)

114 S Sharon Amity Rd
Charlotte, NC 28211-2802
Phone (980) 337-4428

116 S Sharon Amity Rd
Charlotte, NC 28211-2802
Phone (980) 337-4428

13129 S Tryon St
Suite 120
Charlotte, NC 28278-7915
Phone (980) 337-4662

15235 John J Delaney Dr
Suite B
Charlotte, NC 28277-2846
Phone (704) 243-8937

4304 Park Rd
Charlotte, NC 28209-2271
Phone (704) 272-3395

445 S Kings Dr
Charlotte, NC 28204-3041
Phone (980) 308-0141

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010-07235NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Gastonia Physician Services, PLLC CurrentSince Oct 14, 2017 Accepting new patients
Carolina Medicorp Enterprises, LLC CurrentSince Dec 26, 2021 Accepting new patients
Carolina Medicorp Enterprises, LLC CurrentSince Dec 26, 2021 Accepting new patients
Carolina Medicorp Enterprises Inc Past Accepting new patients

Locations

9550 Rocky River Rd
Ste 150
Charlotte, NC 28215
Phone (704) 457-1510

2525 Court Dr
Gastonia, NC 28054
Phone (704) 834-2662

9600 E Independence Blvd
#B
Matthews, NC 28105
Phone (704) 815-5624

600 Highland Oaks Dr
Winston Salem, NC 27103
Phone (366) 774-0040

Interoperability endpoints

  • Direct secure messaging: ecrill424951@direct.novanthealth.org

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1487376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1497294854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "828 SENECA PL",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282102924",
            "telephone_number": "919-274-2558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 CHURCH ST N",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252927",
            "telephone_number": "919-274-2558"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 LeBlanc Ct",
            "address_purpose": "LOCATION",
            "city": "Cary",
            "state": "NC",
            "postal_code": "275133542",
            "country_code": "US",
            "telephone_number": "919-274-2558",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "288 S Ridgecrest Ave",
            "address_purpose": "LOCATION",
            "city": "Rutherfordton",
            "state": "NC",
            "postal_code": "281392838",
            "country_code": "US",
            "telephone_number": "828-286-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLSON",
        "first_name": "EMMA",
        "middle_name": "CRILL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-18",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-07235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA CERTIFICATION",
            "identifier": "1142669",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH CAROLINA MEDICAL LICENSE",
            "identifier": "0010-07235",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

Verify at the official NPI Registry.