NPIMap

Individual provider Active NPI

Randall V Olsen, MD

  • Diagnostic Radiology Physician
  • Columbia, MO
National Provider Identifier
1700875788
Registry record updated May 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2017004467 Issued in MO
Practice address
1600 E Broadway
Columbia, MO 65201-5844
Phone
(573) 815-8000
Fax
(573) 815-6343
NPI assigned
Oct 21, 2005
Last updated
May 2, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2017

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X 6035963-1205 UT
Diagnostic Radiology Physician 2085R0202X 6035963-1205 UT
Diagnostic Radiology Physician 2085R0202X 11771 NV
Diagnostic Radiology Physician 2085R0202X 2017004467 MO Primary
Vascular & Interventional Radiology Physician 2085R0204X 2017004467 MO
Diagnostic Neuroimaging (Radiology) Physician 2085D0003X 6035963-1205 UT

Addresses

Primary practice location

1600 E Broadway
Columbia, MO 65201-5844

Mailing address

PO Box 3242
Indianapolis, IN 46206-3242
Phone (844) 295-4873

Other identifiers 5

IdentifierTypeStateIssuer
870487570RDSOtherUTEMIA
107044372101OtherIHC
870487570004MedicaidUT
60359631200001OtherUTBX
1093702185MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170228001334 MO Practitioner - Diagnostic Radiology 7810952025 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Diagnostic Imaging Associates LTDGroup PAC ID 9638064942, 19 clinicians

Practice addresses (Care Compare)

232 S Woods Mill Rd
St Lukes Hosp Radiology Dept
Chesterfield, MO 63017-3417
Phone (314) 434-1500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11771NVMDDiagnostic Radiology Physician
6035963-1205UTMDDiagnostic Radiology Physician
2017004467MOMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Diagnostic Imaging Associates LTD Diagnostic Radiology CurrentSince Dec 1, 2022 Accepting new patients
Physician Specialists of St Lukes LLC Family Medicine CurrentSince Dec 1, 2025 Accepting new patients
Radiology Imaging of Nebraska, LLC Diagnostic Radiology Past Accepting new patients
Emergency Physicians of St. Luke's, LLC Family Medicine Past Accepting new patients
Radiology Associates of San Luis Obispo, a Medical Group Inc Diagnostic Radiology PastSince Jun 2, 2024 Accepting new patients
Medical Imaging of Colorado Radiology Imaging Assc PC Etal PT Diagnostic Radiology Past Accepting new patients
Scottsdale Medical Imaging, LTD Diagnostic Radiology Past Accepting new patients
Diagnostic Imaging Associates Diagnostic Neuroimaging Past Accepting new patients
Radiology Imaging Associates, PC Diagnostic Radiology Past Accepting new patients
Southwest Diagnostic Imaging LLC Diagnostic Radiology PastSince Apr 20, 2021 Accepting new patients

Locations

121 Saint Lukes Center Dr
Chesterfield, MO 63017
Phone (314) 434-3278

8857 Ladue Rd
Saint Louis, MO 63124
Phone (314) 576-8189

232 S Woods Mill Rd
Town and Country, MO 63017
Phone (314) 205-6030

Organizations & group practices 10

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1129852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493683200000",
    "number": "1700875788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3242",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462063242",
            "telephone_number": "844-295-4873",
            "fax_number": "844-839-0626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 E BROADWAY",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652015844",
            "telephone_number": "573-815-8000",
            "fax_number": "573-815-6343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSEN",
        "first_name": "RANDALL",
        "middle_name": "V",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-21",
        "last_updated": "2017-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "UT",
            "license": "6035963-1205",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "6035963-1205",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NV",
            "license": "11771",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2017004467",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "MO",
            "license": "2017004467",
            "primary": false
        },
        {
            "code": "2085D0003X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Neuroimaging",
            "state": "UT",
            "license": "6035963-1205",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMIA",
            "identifier": "870487570RDS",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHC",
            "identifier": "107044372101",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870487570004",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BX",
            "identifier": "60359631200001",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093702185",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

Verify at the official NPI Registry.