Active NPI
Derek David Olson, M.D.
- Sports Medicine (Family Medicine) Physician
- Gaylord, MI
National Provider Identifier
1497796007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Family Medicine) Physician
- License
- 4301076051
- Practice address
- 652 N Otsego Ave
Gaylord, MI 49735-2502 - Phone
- (989) 732-3529
- Fax
- (989) 732-7865
- NPI assigned
- Jun 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 4301076051 | MI | Primary |
Addresses
Primary practice location
652 N Otsego Ave
Gaylord, MI 49735-2502
Mailing address
652 N Otsego Ave
Gaylord, MI 49735-2502
Phone (989) 732-3529
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4663576 | Medicaid | MI |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | derek-olson@alpinefamilymedicine.e-mdsdirect.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041029000096 | MI | Practitioner - Family Practice | 1759343213 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Wayne State University School of Medicine, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Alpine Family Medicine PLC
Practice addresses (Care Compare)
652 N Otsego Ave
Gaylord, MI 49735-2502
Phone (989) 732-3529
Hospital & facility affiliations
- Munson Home Care
- McLaren Home Health
- Evergreen Home Health
- Munson Healthcare Otsego Memorial Hospital
- McLaren Northern Michigan
- Munson Healthcare Grayling Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alpine Family Medicine PLC | Family Medicine | Current | Accepting new patients |
Locations
652 N Otsego Ave
Gaylord, MI 49735
Phone (989) 732-3529
Interoperability endpoints
- derek-olson@alpinefamilymedicine.e-mdsdirect.com
Organizations & group practices 1
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.
-
- Home Health Agency
- Gaylord, MI
- NPI 1184225021
-
- Home Health Agency
- Cheboygan, MI
- NPI 1538270855
-
- General Acute Care Hospital
- Gaylord, MI
- NPI 1124028972
Hospital
-
- Home Health Agency
- Traverse City, MI
- NPI 1326002577
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609891200000",
"number": "1497796007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "652 N OTSEGO AVE",
"city": "GAYLORD",
"state": "MI",
"postal_code": "497352502",
"telephone_number": "989-732-3529",
"fax_number": "989-732-7865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "652 N OTSEGO AVE",
"city": "GAYLORD",
"state": "MI",
"postal_code": "497352502",
"telephone_number": "989-732-3529",
"fax_number": "989-732-7865"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSON",
"first_name": "DEREK",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-08",
"last_updated": "2021-01-06",
"certification_date": "2021-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "207QS0010X",
"taxonomy_group": "",
"desc": "Family Medicine, Sports Medicine",
"state": "MI",
"license": "4301076051",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4663576",
"state": "MI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "derek-olson@alpinefamilymedicine.e-mdsdirect.com",
"affiliation": "N",
"endpointDescription": "Direct Messaging Address",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "652 N Otsego Ave",
"city": "Gaylord",
"state": "MI",
"country_code": "US",
"postal_code": "497352502",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Gaylord, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2021; 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.