Individual provider Active NPI

Colleen J Olson, M.D.

  • Pediatrics Physician
  • Perrysburg, OH
National Provider Identifier
1497759310
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
OH35078056 Issued in OH
Practice address
1601 Brigham Dr Ste 200
Perrysburg, OH 43551-7117
Phone
(419) 872-7700
Fax
(419) 874-0196
NPI assigned
Jun 9, 2005
Last updated
Nov 3, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X OH35078056 OH Primary

Addresses

Primary practice location

1601 Brigham Dr Ste 200
Perrysburg, OH 43551-7117

Mailing address

1 Seagate Ste 800
Toledo, OH 43604-1558
Phone (419) 872-7700

Other identifiers 2

IdentifierTypeStateIssuer
000000141664OtherOHBLUE CROSS BLUE SHIELD PI
2208444MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address colson28628@epicdirect.promedica.org

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20110105000575 OH Practitioner - Pediatric Medicine 8921297045 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
OH35078056OHMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince Nov 3, 2018 Accepting new patients
Promedica Central Physicians CurrentSince Nov 3, 2018 Accepting new patients

Locations

1601 Brigham Dr
Ste 200
Perrysburg, OH 43551
Phone (419) 872-7700

1620 Brigham Dr
Ste 240
Perrysburg, OH 43551
Phone (419) 872-7700

1 Seagate
#800
Toledo, OH 43604
Phone (567) 585-1964

1 Seagate
Ste 800
Toledo, OH 43604

100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

Interoperability endpoints

  • Direct secure messaging: colson28628@epicdirect.promedica.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1497759310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SEAGATE STE 800",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041558",
            "telephone_number": "419-872-7700",
            "fax_number": "419-874-0196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 BRIGHAM DR STE 200",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435517117",
            "telephone_number": "419-872-7700",
            "fax_number": "419-874-0196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "COLLEEN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-09",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "OH35078056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD PI",
            "identifier": "000000141664",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2208444",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "colson28628@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Perrysburg, OH

Sources for this page

Verify at the official NPI Registry.