Olympic Rehab Wellness and Pain Center PC

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

111213 Issued in MO

Legal business name

OLYMPIC REHAB WELLNESS AND PAIN CENTER PC

Practice address

10420 Old Olive Street Rd Ste 305
Saint Louis, MO 63141-5914

Phone

(314) 849-1003

Fax

(314) 455-3469

NPI assigned

Aug 13, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Alexander Beyzer, M.D.NPI 1063526093

Title

Owner

Phone

(314) 849-1003

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alexander Beyzer, M.D.

  • Pain Medicine Physician
  • Saint Louis, MO
  • NPI 1063526093

  MO

  Medicare reassignment Authorized official
• Tatyana Petrosova, MD

  • Nephrology Physician
  • Saint Louis, MO
  • NPI 1023089562
  NPD
• Kemin Chen, PA

  • Physician Assistant
  • Creve Coeur, MO
  • NPI 1326278102
  NPD (past)
• Marija Grgic, FNP

  • Family Nurse Practitioner
  • Arnold, MO
  • NPI 1104303403
  NPD (past)
• Sylvia L Lommel, ANP

  • Adult Health Nurse Practitioner
  • St Louis, MO
  • NPI 1396827812
  NPD (past)
• Rachel Ann Matusiak, M.S., R.D., L.D.

  • Registered Dietitian
  • Saint Louis, MO
  • NPI 1306075213
  NPD (past)
• Christine Nicola, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Austin, TX
  • NPI 1992240758
  NPD (past)

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717891200000",
    "number": "1669484119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10420 OLD OLIVE STREET RD STE 305",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415914",
            "telephone_number": "314-849-1003",
            "fax_number": "314-455-3469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10420 OLD OLIVE STREET RD STE 305",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415914",
            "telephone_number": "314-849-1003",
            "fax_number": "314-455-3469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLYMPIC REHAB WELLNESS AND PAIN CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-13",
        "last_updated": "2024-06-09",
        "certification_date": "2024-06-09",
        "status": "A",
        "authorized_official_last_name": "BEYZER",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-849-1003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "MO",
            "license": "111213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507194207",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracy M Olson, PMHNP
• Olta Cuci
• Michael Olufawo, MD
• Franklin C Olumba, MD
• Olvera Dental
• James Thomas Omalley
• Hasaan Omar
• Salma Khalid Omar, DO
• Ali Muayyad-Abdulla Omari, MD
• Michael J Ombrello, M.D.

• Pain Medicine Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Pain Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.