Individual provider Active NPI

Olivia Nelson, M.D.

  • Pediatric Anesthesiology Physician
  • Philadelphia, PA
National Provider Identifier
1831400746
Registry record updated Mar 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Anesthesiology PhysicianTaxonomy code 207LP3000X
License
MD460796 Issued in PA
Practice address
3401 Civic Center Blvd
Suite 9329
Philadelphia, PA 19104-4319
Phone
(215) 590-1858
NPI assigned
Jun 24, 2010
Last updated
Mar 27, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X BB5204071-ON4 MA
Student in an Organized Health Care Education/Training Program 390200000X MA
Pediatric Anesthesiology Physician 207LP3000X MD460796 PA Primary

Addresses

Primary practice location

3401 Civic Center Blvd
Suite 9329
Philadelphia, PA 19104-4319

Mailing address

100 East Penn Square
The Wanamaker BLDG., 9TH FL., N
Philadelphia, PA 19107-3323
Phone (267) 425-9320

Other identifiers 1

IdentifierTypeStateIssuer
1033208840001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20170728001608 PA Practitioner - Anesthesiology 7416195169 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD460796PAMDPediatric Anesthesiology Physician
BB5204071-ON4MAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Anesthesiology Associates, LTD Pediatric Anesthesiology CurrentSince Aug 1, 2017 Accepting new patients
Children's Anesthesiology Associates, LTD Pediatric Anesthesiology CurrentSince Aug 1, 2017 Accepting new patients

Locations

100 E Penn Sq
Bldg 9TH
Philadelphia, PA 19107
Phone (267) 425-9538

324 S 34th St
Ste 9329
Philadelphia, PA 19104
Phone (215) 590-1867

3401 Civic Center Blvd
Ste 9329
Philadelphia, PA 19104
Phone (267) 425-9300

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.

NPI Registry JSON

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

{
    "created_epoch": "1277337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522108800000",
    "number": "1831400746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 EAST PENN SQUARE",
            "address_2": "THE WANAMAKER BLDG., 9TH FL., N",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191073323",
            "telephone_number": "267-425-9320",
            "fax_number": "267-425-9331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "address_2": "SUITE 9329",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "215-590-1858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "OLIVIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-24",
        "last_updated": "2018-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MA",
            "license": "BB5204071-ON4",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MA",
            "license": null,
            "primary": false
        },
        {
            "code": "207LP3000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pediatric Anesthesiology",
            "state": "PA",
            "license": "MD460796",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033208840001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.