Derek Olson, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

5101014512 Issued in MI

Practice address

4444 Kalamazoo Ave SE Ste 200
Kentwood, MI 49508

Phone

(616) 391-5600

NPI assigned

Jan 23, 2006

Last updated

Feb 25, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Internal Medicine

Education

Michigan State University College of Human Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Spectrum Health Primary Care PartnersGroup PAC ID 4587568647, 2,283 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Corewell Health Visiting Nurse Association Home health agency, Grand Rapids, MI, CCN 237007
• Spectrum Health Hospital, Grand Rapids, MI, CCN 230038
• Munson Healthcare Otsego Memorial Hospital Hospital, Gaylord, MI, CCN 230133

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dolson215570@epic00.corewelldirect.org
• Direct secure messaging: dolson215570@epic00.shdirect.org

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.

• Spectrum Health Primary Care Partners

  dba Corewell Health Medical Group West

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1235188673
  Medicare reassignment Care Compare group NPD
• Spectrum Health Primary Care Partners

  dba Corewell Health Medical Group West

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1689499667
  NPD

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

• Munson Healthcare Otsego Memorial Hospital

  • General Acute Care Hospital
  • Gaylord, MI
  • NPI 1124028972
  Care Compare affiliation
• Pennock Hospital

  dba Corewell Health Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation
• Spectrum Health Hospitals

  dba Corewell Health Grand Rapids Hospital

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  Care Compare affiliation
• Visiting Nurse Services of Western Michigan

  dba Corewell Health Visiting Nurse Association

  • Home Health Agency
  • Grand Rapids, MI
  • NPI 1659356061
  Care Compare affiliation

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614211200000",
    "number": "1770553901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4444 KALAMAZOO AVE SE STE 200",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "49508",
            "telephone_number": "616-391-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "DEREK",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101014512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036113363",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dolson215570@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "4444 Kalamazoo Ave SE Ste 200",
            "city": "Kentwood",
            "state": "MI",
            "country_code": "US",
            "postal_code": "49508",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "4444 Kalamazoo Ave SE Ste 200",
            "city": "Kentwood",
            "state": "MI",
            "country_code": "US",
            "postal_code": "49508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Natalie Nicole Noud, BEHAVIOR TECHNICIAN
• Stephen A. Novak, D.D.S.
• Autumn Alyssa Nygaard
• Erin O'Brien
• Christina Susan Oisten, R.PH.
• Sarah Elisabeth Olson
• Cassandra Jo Oostindie, ATC
• Arlene Faye Oosting, MSW ACSW
• Alexandra Oppenheimer
• Option One Ventures Inc Dba Acti-Kare Responsive in-Home Care

• Internal Medicine Physician in Kentwood, MI
• Providers in Kentwood, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.