Individual provider Active NPI

Cheryl K Bauer-Olson, DO

  • Family Medicine Physician
  • Fargo, ND
National Provider Identifier
1871553313
Registry record updated May 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
10745 Issued in ND
Practice address
4133 30TH Ave S Ste 103
Fargo, ND 58104-8421
Phone
(701) 499-4847
Fax
(701) 433-1882
NPI assigned
Mar 27, 2006
Last updated
May 15, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 15, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 3656 IA
Family Medicine Physician 207Q00000X 50211 MN
Family Medicine Physician 207Q00000X 10745 ND Primary

Addresses

Primary practice location

4133 30TH Ave S Ste 103
Fargo, ND 58104-8421

Mailing address

2413 E Country Club Dr S
Fargo, ND 58103-5730
Phone (701) 429-4385

Other identifiers 5

IdentifierTypeStateIssuer
0477406MedicaidIA
14436MedicaidND
1871553313MedicaidMN
1871553313OtherNDNDBS
1457451MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, ND2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20071106000289 MN Practitioner - Family Practice 0547281826 Reassigns benefits to 1 organization
I20080610000295 ND Practitioner - Family Practice 0547281826 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4133 30TH Ave S
Suite 103
Fargo, ND 58104-8421
Phone (701) 499-4847

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3656IAMDFamily Medicine Physician
10745NDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Bauer-Olson, Family Doctor, PLLC Family Medicine CurrentSince Sep 1, 2021 Accepting new patients
Willow Health, PLLC Family Medicine CurrentSince Oct 1, 2024 Accepting new patients

Locations

3290 20th St S
Fargo, ND 58104
Phone (701) 499-4800

4133 30th Ave S
Ste 103
Fargo, ND 58104
Phone (701) 499-4847

Interoperability endpoints

  • Direct secure messaging: cheryl.bauerolson@573236023459844.direct.elationemr.com

Organizations & group practices 3

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 5

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": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684108800000",
    "number": "1871553313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2413 E COUNTRY CLUB DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581035730",
            "telephone_number": "701-429-4385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4133 30TH AVE S STE 103",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048421",
            "telephone_number": "701-499-4847",
            "fax_number": "701-433-1882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUER-OLSON",
        "first_name": "CHERYL",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-27",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "3656",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "50211",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "10745",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0477406",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14436",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871553313",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NDBS",
            "identifier": "1871553313",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1457451",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.