NPIMap

Individual provider Active NPI

Kevin R Olsen, PA-C

  • Physician Assistant
  • Lincoln, ME
National Provider Identifier
1871553024
Registry record updated Apr 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-254 Issued in ME
Practice address
175 West Broadway
Lincoln, ME 04457-0000
Phone
(207) 794-6700
Fax
(207) 794-2572
NPI assigned
Mar 23, 2006
Last updated
Apr 5, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-254 ME Primary

Addresses

Primary practice location

175 West Broadway
Lincoln, ME 04457-0000

Mailing address

PO Box 99
Lincoln, ME 04457-0099
Phone (207) 794-6700

Other identifiers 3

IdentifierTypeStateIssuer
100273OtherMEANTHEM
201856OtherMENGS
330920099MedicaidME

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040930000274 ME Practitioner - Physician Assistant 9931178530 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Health Access Network IncGroup PAC ID 2769393180, 24 clinicians

Practice addresses (Care Compare)

175 W Broadway
Lincoln, ME 04457-4000
Phone (207) 794-6700

1930 Medway Rd
Medway, ME 04460-3166
Phone (207) 794-6700

47 Bridge St
West Enfield, ME 04493-4526
Phone (207) 794-6700

PO Box
Suite 99
Lincoln, ME 04457

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA-254MEMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Penobscot Valley Hospital CurrentSince May 29, 2019 Accepting new patients
Millinocket Regional Hospital CurrentSince Apr 1, 2006 Accepting new patients
Health Access Network, Inc. CurrentSince Apr 1, 2006 Accepting new patients
Health Access Network, Inc CurrentSince Apr 1, 2006 Accepting new patients
Millinocket Regional Hospital CurrentSince Apr 1, 2006 Accepting new patients
Health Access Network, Inc. CurrentSince Oct 1, 2021 Accepting new patients
Spectrum Healthcare Partners, PA Past Accepting new patients

Locations

7 Transalpine Rd
Lincoln Ctr, ME 04457
Phone (207) 794-3321

200 Somerset St
Millinocket, ME 04462
Phone (207) 723-3003

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/5664/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir-usa.unify.chbase.com/org/penob-eadbba22
  • FHIR API: https://fhir4.healow.com/fhir/r4/DBFIBD

Organizations & group practices 7

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 7

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": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365120000000",
    "number": "1871553024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99",
            "city": "LINCOLN",
            "state": "ME",
            "postal_code": "044570099",
            "telephone_number": "207-794-6700",
            "fax_number": "207-794-6777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 WEST BROADWAY",
            "city": "LINCOLN",
            "state": "ME",
            "postal_code": "044570000",
            "telephone_number": "207-794-6700",
            "fax_number": "207-794-2572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSEN",
        "first_name": "KEVIN",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2013-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA-254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "100273",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NGS",
            "identifier": "201856",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "330920099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, ME

Sources for this page

Verify at the official NPI Registry.