Active NPI
Michael Shawn Olaughlin, PHD
- Psychologist
- Fargo, ND
National Provider Identifier
1790878957
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 350
- Practice address
- 510 4TH St South
Fargo, ND 58103 - Phone
- (701) 476-7800
- NPI assigned
- Oct 2, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 350 | ND | Primary |
| Psychologist | 103T00000X | 3493 | MN |
Addresses
Primary practice location
510 4TH St South
Fargo, ND 58103
Mailing address
830 12TH St North
Breckenridge, MN 56520
Phone (218) 643-8714
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11928 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 350 | ND | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prairie St Johns | Past | Accepting new patients | |
| PSJ Acquisition LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Psychiatric Hospital
- Fargo, ND
- NPI 1417901000
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790878957",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "830 12TH ST NORTH",
"city": "BRECKENRIDGE",
"state": "MN",
"postal_code": "56520",
"telephone_number": "218-643-8714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 4TH ST SOUTH",
"city": "FARGO",
"state": "ND",
"postal_code": "58103",
"telephone_number": "701-476-7800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLAUGHLIN",
"first_name": "MICHAEL",
"middle_name": "SHAWN",
"name_prefix": "Mr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "ND",
"license": "350",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "3493",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "11928",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.