Individual provider Active NPI

Mallery Olsen, MD

  • Pediatric Hematology & Oncology Physician
  • Minneapolis, MN
National Provider Identifier
1649664871
Registry record updated Oct 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X
License
80064 Issued in MN
Practice address
2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone
(612) 365-8100
NPI assigned
Mar 25, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Hematology & Oncology Physician 2080P0207X 80064 MN Primary
General Practice Physician 208D00000X 80064 MN

Addresses

Primary practice location

2450 Riverside Ave
Minneapolis, MN 55454-1450

Mailing address

2450 Riverside Ave # 8951
Minneapolis, MN 55454-1450

Other identifiers 1

IdentifierTypeStateIssuer
163982MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250626004262 MN Practitioner - Hematology/OncologyPractitioner - Pediatric Medicine 4688984420 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/OncologyAlso: Pediatric Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

500 Harvard St SE
Minneapolis, MN 55455-0363
Phone (612) 672-7422

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Hennepin Healthcare System Inc CurrentSince Jul 1, 2025 Accepting new patients
University of Minnesota Health Clinics and Surgery Center, Inc. CurrentSince Jul 31, 2025 Accepting new patients
Fairview Express Care Current Accepting new patients
University of Minnesota Physicians Current Accepting new patients
Phoenix Children'S Hospital Pediatrics Current Accepting new patients
Hennepin Healthcare System, Inc CurrentSince Jul 1, 2025 Accepting new patients
University of Minnesota Health Clinics and Surgery Center Inc CurrentSince Jul 31, 2025 Accepting new patients
Fairview Express Care CurrentSince Jul 31, 2025 Accepting new patients
Phoenix Children'S Medical Group CurrentSince Jul 1, 2022 Accepting new patients
Fairview Express Care General Practice CurrentSince Jul 31, 2025 Accepting new patients
University of Minnesota Physicians CurrentSince Jul 31, 2025 Accepting new patients
Phoenix Children'S Medical Group CurrentSince Jul 1, 2022 Accepting new patients
University of Minnesota Physicians CurrentSince Jul 31, 2025 Accepting new patients
Phoenix Children'S Hospital Past Accepting new patients
Fairview Health Services Past Accepting new patients
Fairview Health Services PastSince Jun 1, 2026 Accepting new patients

Locations

1665 N Avondale Blvd
Avondale, AZ 85392
Phone (602) 933-0005

2108 E Thomas Rd
Ste 130
Phoenix, AZ 85016

1919 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 933-0777

2450 Riverside Ave
#8951
Minneapolis, MN 55454

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

701 Park Ave
Minneapolis, MN 55415
Phone (612) 873-6005

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

909 Fulton St SE
Ste 214
Minneapolis, MN 55455

516 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-3600

1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740

Interoperability endpoints

  • Direct secure messaging: molsen2677839@fairview.direct-ci.com

Organizations & group practices 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1427241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761264000000",
    "number": "1649664871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE # 8951",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-365-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSEN",
        "first_name": "MALLERY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-25",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "MN",
            "license": "80064",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MN",
            "license": "80064",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163982",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.