NPIMap

Individual provider Active NPI

Samuel John Olsen II, MD

  • Internal Medicine Physician
  • Etowah, TN
National Provider Identifier
1760448591
Registry record updated Nov 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
039591 Issued in TN
Practice address
301 Grady Rd
Etowah, TN 37331-0325
Phone
(423) 263-2444
Fax
(423) 263-1553
NPI assigned
Apr 21, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 7, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 039591 TN Primary
Sports Medicine (Internal Medicine) Physician 207RS0010X 039591 TN

Addresses

Primary practice location

301 Grady Rd
Etowah, TN 37331-0325

Mailing address

PO Box 325
Etowah, TN 37331-0325
Phone (423) 263-2444

Other identifiers 3

IdentifierTypeStateIssuer
3330104MedicaidTN
4108690OtherTNBCBS
P00237341OtherTNMEDICARE RR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20050627001129 TN Practitioner - Internal Medicine 1951377324 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
East Tennessee State University Quillen College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Medical Group, PLLCGroup PAC ID 2860396330, 636 clinicians

Practice addresses (Care Compare)

1225 E Weisgarber Rd
Suite 200
Knoxville, TN 37849-4016
Phone (865) 938-3627

1275 Dick Lonas Rd
Knoxville, TN 37909-1326

201 E Emory Rd
Powell, TN 37849-4016
Phone (865) 938-3627

301 Grady Rd
Etowah, TN 37331-1924
Phone (423) 263-1743

9333 Park W Blvd
Knoxville, TN 37923-4305

Hospital & facility affiliations

  • Enhabit Home Health Home health agency, Knoxville, TN, CCN 447142
  • Accentcare Home Health of Tennessee Home health agency, Chattanooga, TN, CCN 447559
  • Amedisys Home Health Chattanooga Home health agency, Chattanooga, TN, CCN 447156
  • Adoration Home Health and Hospice Care East TN Home health agency, Cleveland, TN, CCN 447279
  • Hospice of Chattanooga Holdings, LLC Hospice, Chattanooga, TN, CCN 441504
  • Hearth Hospice Hospice, Chattanooga, TN, CCN 441600
  • Gentiva Hospice, Nashville, TN, CCN 441545
  • Starr Regional Medical Center Athens Hospital, Athens, TN, CCN 440068
  • Memorial Healthcare System, Inc Hospital, Chattanooga, TN, CCN 440091
  • Starr Regional Health & Rehabilitation Nursing home, Etowah, TN, CCN 445277
  • Life Care Center of Athens Nursing home, Athens, TN, CCN 445298
  • Etowah Health and Rehabilitation Nursing home, Etowah, TN, CCN 445422

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
039591TNMDSports Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, PLLC Internal Medicine CurrentSince Nov 1, 2022 Accepting new patients
Summit Medical Group, PLLC Internal Medicine CurrentSince Nov 1, 2022 Accepting new patients
Southeastern Health Facilities Inc Past Accepting new patients
Athens Regional Medical Center LLC Past Accepting new patients
Alabama Sports Medicine and Ortho Center Past Accepting new patients
Andrews Sports Medicine and Orthopaedic Center Past Accepting new patients
Summit Medical Group, PLLC Internal Medicine Past Accepting new patients
Life Care Centers of America, Inc. Past Accepting new patients

Locations

301 Grady Rd
Etowah, TN 37331
Phone (423) 263-1743

1225 E Weisgarber Rd
Ste 200
Knoxville, TN 37909
Phone (865) 938-3627

Interoperability endpoints

  • Direct secure messaging: samuel.olsen.1@20785.direct.athenahealth.com
  • Direct secure messaging: samuelolsen@imatn.allscriptsdirect.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Starr Regional Health & RehabilitationEtowah, TN, CCN 445277 Skilled nursing facility Adp of the SNF Jul 14, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194393600000",
    "number": "1760448591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 325",
            "city": "ETOWAH",
            "state": "TN",
            "postal_code": "373310325",
            "telephone_number": "423-263-2444",
            "fax_number": "423-263-1553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 GRADY RD",
            "city": "ETOWAH",
            "state": "TN",
            "postal_code": "373310325",
            "telephone_number": "423-263-2444",
            "fax_number": "423-263-1553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSEN",
        "first_name": "SAMUEL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2007-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "039591",
            "primary": true
        },
        {
            "code": "207RS0010X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sports Medicine",
            "state": "TN",
            "license": "039591",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3330104",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4108690",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "P00237341",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Etowah, TN

Sources for this page

Verify at the official NPI Registry.