Providence Health Group LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PROVIDENCE HEALTH GROUP LLC

Practice address

300 W Osborn Rd Ste 110
Phoenix, AZ 85013-3922

Phone

(602) 265-1210

Fax

(602) 265-1222

NPI assigned

Sep 25, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Roger B Olade, MD

Title

Owner/Physician

Phone

(404) 441-8752

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Genesis Wellness & Pain Management Center Doing business as

Locations

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

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308614400000",
    "number": "1841487709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W OSBORN RD STE 110",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850133922",
            "telephone_number": "602-265-1210",
            "fax_number": "602-265-1222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W OSBORN RD STE 110",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850133922",
            "telephone_number": "602-265-1210",
            "fax_number": "602-265-1222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-25",
        "last_updated": "2011-06-21",
        "status": "A",
        "authorized_official_last_name": "OLADE",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "404-441-8752",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269526",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis Wellness & Pain Management Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brandi Protonentis
• Jeffrey C Proudfoot, D.O.
• Proudly Arizona LLC
• Providence General Medicine
• Providence General Medicine, PC
• Providence Hospice and Palliative Care Inc
• Providence of Arizona, Inc.
• Providence Pediatrics
• Providential Western Medical
• Province Anesthesia LLC

• Internal Medicine Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Internal Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.