Individual provider Active NPI

Illana Olden, DNP

  • Gerontology Nurse Practitioner
  • Cincinnati, OH
National Provider Identifier
1740070440
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
APRN.CNP.0039206 Issued in OH
Practice address
6423 Lisbon Ave
Cincinnati, OH 45213-1229
Phone
(513) 953-3166
NPI assigned
May 7, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X APRN.CNP.0039206 OH Primary

Addresses

Primary practice location

6423 Lisbon Ave
Cincinnati, OH 45213-1229

Mailing address

6423 Lisbon Ave
Cincinnati, OH 45213-1229
Phone (513) 953-3166

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250623003918 OH Practitioner - Nurse Practitioner 2163934480 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cleveland Surgical Associates, Inc.Group PAC ID 3577566371, 26 clinicians
Encore Clinical Services LLCGroup PAC ID 5991177313, 49 clinicians

Practice addresses (Care Compare)

12301 Ridge Rd
North Royalton, OH 44133-3744
Phone (440) 652-8748

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
APRN.CNP.0039206OHMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cleveland Surgical Associates, Inc. CurrentSince Jun 1, 2025 Accepting new patients
Lake Effect Health Current Accepting new patients
Encore Clinical Services LLC Gerontology CurrentSince Jun 1, 2025 Accepting new patients

Locations

12301 Ridge Rd
Ste 100
North Royalton, OH 44133

12301 Ridge Rd
North Royalton, OH 44133
Phone (216) 331-6750

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1746576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746576000000",
    "number": "1740070440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6423 LISBON AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452131229",
            "telephone_number": "513-953-3166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6423 LISBON AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452131229",
            "telephone_number": "513-953-3166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLDEN",
        "first_name": "ILLANA",
        "name_prefix": "Mrs.",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-07",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OH",
            "license": "APRN.CNP.0039206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.