Individual provider Active NPI

Kendall Lee Olson-Cassidy

  • Advanced Practice Midwife
  • Medford, OR
National Provider Identifier
1902193527
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
201250156NP Issued in OR
Practice address
1910 E Barnett Rd Ste 102
Medford, OR 97504-8672
Phone
(541) 500-4747
NPI assigned
Jul 3, 2011
Last updated
Feb 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 201250156NP OR
Advanced Practice Midwife 367A00000X 201250156NP OR Primary
Registered Nurse 163W00000X 201042785RN OR

Addresses

Primary practice location

1910 E Barnett Rd Ste 102
Medford, OR 97504-8672

Mailing address

1910 E Barnett Rd Ste 102
Medford, OR 97504-8672
Phone (541) 500-4747

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131108001598 OR Practitioner - Certified Nurse Midwife (CNM) 2466602537 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Nurse Midwife (CNM)
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Oregon Gynecology LLCGroup PAC ID 5991223273, 4 clinicians

Practice addresses (Care Compare)

2850 State St
Medford, OR 97504-8474
Phone (541) 500-4747

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
201250156NPORMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Oregon Gynecology LLC CurrentSince Apr 16, 2025 Accepting new patients

Locations

1910 E Barnett Rd
Ste 102
Medford, OR 97504
Phone (541) 500-4747

2850 State St
Medford, OR 97504
Phone (541) 773-5500

Organizations & group practices 1

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 2

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": "1309651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1902193527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 E BARNETT RD STE 102",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048672",
            "telephone_number": "541-500-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 E BARNETT RD STE 102",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048672",
            "telephone_number": "541-500-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON-CASSIDY",
        "first_name": "KENDALL",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-03",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "OR",
            "license": "201250156NP",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "OR",
            "license": "201250156NP",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "201042785RN",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.