NPIMap

Organization Active NPI

Superior Walk-in Center, PC

  • Family Medicine Physician
  • Marquette, MI
National Provider Identifier
1497806418
Registry record updated Jul 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SUPERIOR WALK-IN CENTER, PC
Practice address
1414 W Fair Ave
Suite 134
Marquette, MI 49855-2675
Phone
(906) 226-2233
Fax
(906) 226-2409
NPI assigned
Jan 16, 2007
Last updated
Jul 14, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2008

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

Authorized official

Name
Dr. Kurt Richard Olson, M.D.NPI 1457309569
Title
President
Phone
(906) 387-4220

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1414 W Fair Ave
Suite 134
Marquette, MI 49855-2675

Mailing address

1504 Sand Point Rd
Munising, MI 49862-1406
Phone (906) 387-4220

Other identifiers 6

IdentifierTypeStateIssuer
135602000OtherMIUNITED STATES POST OFFICE
135602000OtherMIUS DEPT OF LABOR
080Z210080OtherMIBLUE CROSS GROUP
0800217321OtherMIBLUE CROSS OF MI
23D961305OtherMICLIA
3114604MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070123000220 MI Part B Supplier - Clinic/Group Practice 6204837057 Receives reassigned benefits from 14 practitioners
2 other NPIs on this enrollment
Practice locations: Marquette, MI; Munising, MI

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1504 Sandpoint Rd
Munising, MI 49862
Phone (906) 387-4220

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1497806418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 SAND POINT RD",
            "city": "MUNISING",
            "state": "MI",
            "postal_code": "498621406",
            "telephone_number": "906-387-4220",
            "fax_number": "906-387-5449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 W FAIR AVE",
            "address_2": "SUITE 134",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498552675",
            "telephone_number": "906-226-2233",
            "fax_number": "906-226-2409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERIOR WALK-IN CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "KURT",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "906-387-4220",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED STATES POST OFFICE",
            "identifier": "135602000",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR",
            "identifier": "135602000",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP",
            "identifier": "080Z210080",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MI",
            "identifier": "0800217321",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "23D961305",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3114604",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marquette, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.