Active NPI
Dettleff Elmer Olson, D.O.
- Family Medicine Physician
- Dayton, OH
National Provider Identifier
1497868475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 34-005936
- Practice address
- 4100 W 3Rd St
Dayton, OH 45428-9000 - Phone
- (765) 973-6915
- NPI assigned
- Aug 16, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 34-005936 | OH | Primary |
Addresses
Primary practice location
4100 W 3Rd St
Dayton, OH 45428-9000
Mailing address
405 Valleyview Dr
Englewood, OH 45322-1313
Phone (937) 836-5597
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130207000202 | OH | Order and Referring Only - Family Practice | 7517920648 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34-005936 | OH | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dayton VA | Past | Accepting new patients | |
| Family Medicine Care, LLC | Family Medicine | Past | Accepting new patients |
| Lima Memorial Joint Operating Company | Past | Accepting new patients | |
| Miami Valley Podiatry Associates LLC | Past | Accepting new patients |
Organizations & group practices 4
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.
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- NPI 1164755096
-
- Military Hospital
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- NPI 1346262813
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497868475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "405 VALLEYVIEW DR",
"city": "ENGLEWOOD",
"state": "OH",
"postal_code": "453221313",
"telephone_number": "937-836-5597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4100 W 3RD ST",
"city": "DAYTON",
"state": "OH",
"postal_code": "454289000",
"telephone_number": "765-973-6915"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSON",
"first_name": "DETTLEFF",
"middle_name": "ELMER",
"name_prefix": "Miss",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OH",
"license": "34-005936",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.