Individual provider Active NPI

Gwenivere Stanton Olsen

  • Advanced Practice Midwife
  • Plymouth, MA
National Provider Identifier
1760859375
Registry record updated Aug 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
RN2301907 Issued in MA
Practice address
275 Sandwich St
Plymouth, MA 02360-2183
Phone
(909) 702-3935
NPI assigned
Aug 31, 2015
Last updated
Aug 31, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X RN2301907 MA Primary

Addresses

Primary practice location

275 Sandwich St
Plymouth, MA 02360-2183

Mailing address

40 Obery St
Attn: Kristy Glavin, Beth Israel Deaconess OBGYN
Plymouth, MA 02360-2196

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151207002877 MA Practitioner - Certified Nurse Midwife (CNM) 0547560971 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Nurse Midwife (CNM)
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Essex County OBGYN Assoc IncGroup PAC ID 6204829062, 26 clinicians

Practice addresses (Care Compare)

83 Herrick St
Suite 2004
Beverly, MA 01915-2757
Phone (978) 927-4800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Essex County OBGYN Assoc Inc CurrentSince Oct 15, 2019 Accepting new patients
Beth Israel Lahey Health Specialty Care, Inc. Past Accepting new patients
Northeast Hospital Corporation Past Accepting new patients

Locations

83 Herrick St
Ste 2004
Beverly, MA 01915
Phone (978) 927-4800

83 Herrick St
Ste 3002
Beverly, MA 01915
Phone (978) 750-8300

140 Commonwealth Ave
Ste 208
Danvers, MA 01923
Phone (978) 232-5538

480 Maple St
Ste 303
Danvers, MA 01923

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": "1440979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440979200000",
    "number": "1760859375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 OBERY ST",
            "address_2": "ATTN: KRISTY GLAVIN, BETH ISRAEL DEACONESS OBGYN",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "023602196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 SANDWICH ST",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "023602183",
            "telephone_number": "909-702-3935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSEN",
        "first_name": "GWENIVERE",
        "middle_name": "STANTON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-31",
        "last_updated": "2015-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "MA",
            "license": "RN2301907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MA

Sources for this page

Verify at the official NPI Registry.