Individual provider Active NPI

Landon L Olson, DO

  • Pediatrics Physician
  • Columbia, MO
National Provider Identifier
1700456811
Registry record updated Jun 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
2021024174 Issued in MO
Practice address
404 N Keene St
Columbia, MO 65201-6626
Phone
(573) 882-4438
NPI assigned
Jun 30, 2021
Last updated
Jun 30, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2021024174 MO Primary

Addresses

Primary practice location

404 N Keene St
Columbia, MO 65201-6626

Mailing address

400 N Keene St
Columbia, MO 65201-6626
Phone (573) 882-4438

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
I20240722003206 MN Practitioner - Pediatric Medicine 1153867569 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2021024174MOMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic Current Accepting new patients
Centracare Clinic CurrentSince Jul 10, 2024 Accepting new patients
Centracare Clinic CurrentSince Jul 10, 2024 Accepting new patients

Locations

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

Interoperability endpoints

  • Direct secure messaging: lolson826838@direct.centracare.com

Organizations & group practices 3

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": "1625011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1700456811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N KEENE ST",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652016626",
            "telephone_number": "573-882-4438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 N KEENE ST",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652016626",
            "telephone_number": "573-882-4438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "LANDON",
        "middle_name": "L",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-30",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2021024174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

Verify at the official NPI Registry.