NPIMap

Individual provider Active NPI

Russell G Olsen, DPM

  • Podiatrist
  • Cedar City, UT
National Provider Identifier
1639178882
Registry record updated Dec 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
106765-0501 Issued in UT
Practice address
1811 W Royal Hunte Dr
Suite 2
Cedar City, UT 84720-8273
Phone
(435) 586-2225
Fax
(435) 867-1909
NPI assigned
Jul 19, 2005
Last updated
Dec 28, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 106765-0501 UT Primary

Addresses

Primary practice location

1811 W Royal Hunte Dr
Suite 2
Cedar City, UT 84720-8273

Mailing address

1811 W Royal Hunte Dr
Suite 2
Cedar City, UT 84720-8273
Phone (435) 586-2225

Other identifiers 6

IdentifierTypeStateIssuer
167286OtherUTDMBA
528688204001OtherUTBLUECROSS PPO
870545030006OtherUTMEDICAID DME
1069500001OtherUTRR MEDICARE DME
870545030OL1OtherUTEDUCATORS MUTUAL
73654OtherUTINTERMOUNTAIN HEALTH CARE

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
106765-0501UTMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Foot & Ankle Podiatrist 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198800000000",
    "number": "1639178882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 W ROYAL HUNTE DR",
            "address_2": "SUITE 2",
            "city": "CEDAR CITY",
            "state": "UT",
            "postal_code": "847208273",
            "telephone_number": "435-586-2225",
            "fax_number": "435-867-1909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 W ROYAL HUNTE DR",
            "address_2": "SUITE 2",
            "city": "CEDAR CITY",
            "state": "UT",
            "postal_code": "847208273",
            "telephone_number": "435-586-2225",
            "fax_number": "435-867-1909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSEN",
        "first_name": "RUSSELL",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2007-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "UT",
            "license": "106765-0501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "167286",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS PPO",
            "identifier": "528688204001",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "870545030006",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE DME",
            "identifier": "1069500001",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDUCATORS MUTUAL",
            "identifier": "870545030OL1",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERMOUNTAIN HEALTH CARE",
            "identifier": "73654",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.