Active NPI
Amanda G. Olsen, PA
- Medical Physician Assistant
- Lumberton, NC
National Provider Identifier
1609143411
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA.200488
- Practice address
- 300 W 27TH St
Lumberton, NC 28358-3075 - Phone
- (910) 671-5032
- NPI assigned
- Nov 22, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA.200488 | LA | Primary |
Addresses
Primary practice location
300 W 27TH St
Lumberton, NC 28358-3075
Mailing address
300 W 27TH St
Lumberton, NC 28358-3075
Phone (910) 671-5032
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01825596 | Medicaid | MS | |
| 2171305 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lumberton Emergency Medical Associates PC | Past | Accepting new patients |
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.
-
- Emergency Medicine Physician
- Lumberton, NC
- NPI 1326337163
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384473600000",
"number": "1609143411",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 W 27TH ST",
"city": "LUMBERTON",
"state": "NC",
"postal_code": "283583075",
"telephone_number": "910-671-5032"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W 27TH ST",
"city": "LUMBERTON",
"state": "NC",
"postal_code": "283583075",
"telephone_number": "910-671-5032"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSEN",
"first_name": "AMANDA",
"middle_name": "G.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-22",
"last_updated": "2013-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "LA",
"license": "PA.200488",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01825596",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2171305",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lumberton, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.