NPIMap

Individual provider Active NPI

Olivia Martin, PA

  • Physician Assistant
  • Council Bluffs, IA
National Provider Identifier
1811780414
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
132844 Issued in IA
Practice address
900 Woodbury Ave Ste 8B
Council Bluffs, IA 51503-7855
Phone
(712) 796-2545
Fax
(712) 847-6095
NPI assigned
May 27, 2025
Last updated
Jan 15, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3285 NE
Physician Assistant 363A00000X 132844 IA Primary

Addresses

Primary practice location

900 Woodbury Ave Ste 8B
Council Bluffs, IA 51503-7855

Mailing address

900 Woodbury Ave Ste 8B
Council Bluffs, IA 51503-7855
Phone (712) 796-2545

Other practice location 1

103 North Ave Ste 8
Council Bluffs, IA 51503-1613
Phone (712) 796-2545

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, IA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250814001781 NE Practitioner - Physician Assistant 2860991221 Reassigns benefits to 1 organization
I20250814001851 IA Practitioner - Physician Assistant 2860991221 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shenandoah Medical CenterGroup PAC ID 9436063237, 52 clinicians
Advanced Kidney Care, PLLCGroup PAC ID 2769830082, 5 clinicians

Practice addresses (Care Compare)

1 Jack Foster Dr
Shenandoah, IA 51601-4586
Phone (712) 246-7240

103 N Ave
Suite 8
Council Bluffs, IA 51503-1613
Phone (712) 796-2545

800 Mercy Dr
Council Bluffs, IA 51503-3128
Phone (712) 328-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3285NEMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Montgomery County Memorial Hospital Physician Assistant CurrentSince Oct 1, 2025 Accepting new patients
Montgomery County Memorial Hospital CurrentSince Oct 1, 2025 Accepting new patients
Montgomery County Memorial Hospital CurrentSince Oct 1, 2025 Accepting new patients
Shenandoah Medical Center Past Accepting new patients

Locations

2301 Eastern Ave
Red Oak, IA 51566
Phone (712) 623-7270

1 Jack Foster Dr
Shenandoah, IA 51601
Phone (712) 246-7240

Organizations & group practices 6

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1748304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768435200000",
    "number": "1811780414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 WOODBURY AVE STE 8B",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515037855",
            "telephone_number": "712-796-2545",
            "fax_number": "712-847-6095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 WOODBURY AVE STE 8B",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515037855",
            "telephone_number": "712-796-2545",
            "fax_number": "712-847-6095"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "103 North Ave Ste 8",
            "address_purpose": "LOCATION",
            "city": "Council Bluffs",
            "state": "IA",
            "postal_code": "515031613",
            "country_code": "US",
            "telephone_number": "712-796-2545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "OLIVIA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-27",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "3285",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "132844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

Verify at the official NPI Registry.