Active NPI
Haley Olsen
- Family Medicine Physician
- Peoria, IL
National Provider Identifier
1861180382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036179036
- Practice address
- 815 Main St Ste a
Peoria, IL 61602-1080 - Phone
- (309) 672-4977
- Fax
- (309) 671-2580
- NPI assigned
- Apr 25, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | 036179036 | IL | Primary |
Addresses
Primary practice location
815 Main St Ste a
Peoria, IL 61602-1080
Mailing address
815 Main St Ste a
Peoria, IL 61602-1080
Phone (309) 672-4977
Other practice location 1
3800 S National Ave Ste 700
Springfield, MO 65807-5279
Phone (417) 269-8817
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
221 NE Glen Oak Ave
Peoria, IL 61636-0001
511 Chloe Rd
Pikeville, KY 41501-1585
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Interoperability endpoints
- haley.olsen.p1@direct.jordanvalley.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782864000000",
"number": "1861180382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "815 MAIN ST STE A",
"city": "PEORIA",
"state": "IL",
"postal_code": "616021080",
"telephone_number": "309-672-4977",
"fax_number": "309-671-2580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "815 MAIN ST STE A",
"city": "PEORIA",
"state": "IL",
"postal_code": "616021080",
"telephone_number": "309-672-4977",
"fax_number": "309-671-2580"
}
],
"practiceLocations": [
{
"address_1": "3800 S National Ave Ste 700",
"address_purpose": "LOCATION",
"city": "Springfield",
"state": "MO",
"postal_code": "658075279",
"country_code": "US",
"telephone_number": "417-269-8817",
"fax_number": "417-269-8744",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "OLSEN",
"first_name": "HALEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-25",
"last_updated": "2026-07-01",
"certification_date": "2026-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036179036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2026; 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.