Active NPI
Ross G Olness, D.D.S.
- Dentist
- Willmar, MN
National Provider Identifier
1659579043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D12383
- Practice address
- 1604 1St St S
Skylark Center
Willmar, MN 56201-4243 - Phone
- (320) 231-1739
- NPI assigned
- Jul 6, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | D12383 | MN | Primary |
Addresses
Primary practice location
1604 1St St S
Skylark Center
Willmar, MN 56201-4243
Mailing address
1280 West Lawrence Rd
Cloquet, MN 55720
Phone (651) 983-9113
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160527001374 | MN | Order and Referring Only - Other (Non-Physician) | 9032409370 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D12383 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186012800000",
"number": "1659579043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1280 WEST LAWRENCE RD",
"city": "CLOQUET",
"state": "MN",
"postal_code": "55720",
"telephone_number": "651-983-9113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1604 1ST ST S",
"address_2": "SKYLARK CENTER",
"city": "WILLMAR",
"state": "MN",
"postal_code": "562014243",
"telephone_number": "320-231-1739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLNESS",
"first_name": "ROSS",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-06",
"last_updated": "2007-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D12383",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willmar, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 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.