Charles S Olsen, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5101013811 Issued in MI

Practice address

128 Michigan Ave
Gladstone, MI 49837-1929

Phone

(906) 428-4084

Fax

(906) 428-1881

NPI assigned

Aug 5, 2006

Last updated

Jul 8, 2007By 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 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

Family Practice

Education

Michigan State University College of Osteopathic Medicine, 1998

Medicare assignment

May accept Medicare assignment

Group practices

St Francis HospitalGroup PAC ID 5991604753, 85 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Osf St Francis Hospital and Medical Group Hospital, Escanaba, MI, CCN 231337

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• St. Francis Hospital

  dba OFSMG - Women's Center

  • Obstetrics & Gynecology Physician
  • Escanaba, MI
  • NPI 1700828837
  Medicare reassignment Care Compare group NPD
• St Francis Hospital

  dba St Francis Hospital of Escanaba - Pathology

  • Anatomic Pathology & Clinical Pathology Physician
  • Escanaba, MI
  • NPI 1598036196
  NPD (past)
• St Francis Hospital

  dba St Francis Hospital Medical Group - Powers Clinic

  • Rural Health Clinic/Center
  • Powers, MI
  • NPI 1952554479
  NPD (past)
• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  NPD (past)

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

• St Francis Hospital

  dba OSF Healthcare St. Francis Hospital & Medical Group

  • Critical Access Hospital
  • Escanaba, MI
  • NPI 1922058551
  Care Compare affiliation

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821007451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 MICHIGAN AVE",
            "city": "GLADSTONE",
            "state": "MI",
            "postal_code": "498371929",
            "telephone_number": "906-428-4084",
            "fax_number": "906-428-1881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 MICHIGAN AVE",
            "city": "GLADSTONE",
            "state": "MI",
            "postal_code": "498371929",
            "telephone_number": "906-428-4084",
            "fax_number": "906-428-1881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSEN",
        "first_name": "CHARLES",
        "middle_name": "S",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101013811",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4549419",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP#CC2139",
            "identifier": "P00059355",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Maynarich, LMT
• Maryanne Wojda McLeod, MSW, LMSW, ACSW
• Murrays Country View
• Northwoods Rehabilitation Inc.
• Carley O'Neal, DPT, PT
• Jenilee Pellegrini
• Peninsula Pharmacy Gladstone LLC
• Richard Charles Pfotenhauer, D.D.S., P.C.
• Scott A Randall, M.D.
• Matthew Rayeski, DO

• Family Medicine Physician in Gladstone, MI
• Providers in Gladstone, MI by specialty
• Family Medicine Physician in Michigan

• 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.
• 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.