Individual provider Active NPI

Olivia Rose Johnson

  • Family Nurse Practitioner
  • Rochester, NY
National Provider Identifier
1629820816
Registry record updated Aug 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
354978 Issued in NY
Practice address
125 Lattimore Rd Ste 258
Rochester, NY 14620-4155
Phone
(585) 442-8020
NPI assigned
Apr 2, 2024
Last updated
Aug 9, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 744904 NY
Family Nurse Practitioner 363LF0000X 354978 NY Primary

Addresses

Primary practice location

125 Lattimore Rd Ste 258
Rochester, NY 14620-4155

Mailing address

7276 Gillis Rd
Victor, NY 14564-9541
Phone (716) 785-0659

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240828003262 NY Practitioner - Nurse Practitioner 3375082878 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
GYN Oncology Group of the University of RochesterGroup PAC ID 6800836784, 13 clinicians

Practice addresses (Care Compare)

125 Lattimore Rd
Suite 258
Rochester, NY 14620-4155
Phone (585) 442-8020

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
744904NYMDRegistered Nurse
354978NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
GYN Oncology Group of the University of Rochester CurrentSince Aug 1, 2024 Accepting new patients

Locations

601 Elmwood Ave
#668
Rochester, NY 14642
Phone (585) 275-2691

125 Lattimore Rd
Ste 258
Rochester, NY 14620
Phone (585) 442-8020

Interoperability endpoints

  • Direct secure messaging: otrippi103659@direct.urmc.rochester.edu

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1712016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723161600000",
    "number": "1629820816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7276 GILLIS RD",
            "city": "VICTOR",
            "state": "NY",
            "postal_code": "145649541",
            "telephone_number": "716-785-0659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 LATTIMORE RD STE 258",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146204155",
            "telephone_number": "585-442-8020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "OLIVIA",
        "middle_name": "ROSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-02",
        "last_updated": "2024-08-09",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "744904",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "354978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.