NPIMap

Individual provider Active NPI

Blaine Olsen, D.O.

  • Family Medicine Physician
  • Pocatello, ID
National Provider Identifier
1922236454
Registry record updated Dec 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MR-1066 Issued in ID
Practice address
1951 Bench Rd
Ste B
Pocatello, ID 83201-2073
Phone
(208) 238-1000
Fax
(208) 238-0009
NPI assigned
Jun 23, 2009
Last updated
Dec 17, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MR-1066 ID Primary

Addresses

Primary practice location

1951 Bench Rd
Ste B
Pocatello, ID 83201-2073

Mailing address

1951 Bench Rd
Ste B
Pocatello, ID 83201-2073
Phone (208) 238-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20120806000902 ID Practitioner - Family Practice 6103072251 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Practice Group, P.a.Group PAC ID 1658275391, shared by 2 NPIs, 14 clinicians

Practice addresses (Care Compare)

1951 Bench Rd
Pocatello, ID 83201-2073
Phone (208) 238-1000

1951 Bench Rd B
Pocatello, ID 83201-2073

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MR-1066IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pocatello Health Services, LLC CurrentSince Aug 11, 2015 Accepting new patients
Family Practice Group, P.a. Family Medicine CurrentSince May 8, 2012 Accepting new patients
Pocatello Health Services, LLC CurrentSince Aug 11, 2015 Accepting new patients
Pocatello Health Services, LLC Current Accepting new patients
Pocatello Hospital LLC Current Accepting new patients
Family Practice Group, P.a. CurrentSince May 8, 2012 Accepting new patients
Division of Veterans Services Past Accepting new patients

Locations

1951 Bench Rd
Ste B
Pocatello, ID 83201
Phone (208) 238-1000

1951 Bench Rd
Ste D
Pocatello, ID 83201
Phone (208) 237-1151

465 Memorial Dr
Pocatello, ID 83201
Phone (208) 234-4700

777 Hospital Way
Pocatello, ID 83201
Phone (208) 239-1000

777 Hospital Way
Ste 202
Pocatello, ID 83201
Phone (208) 239-2640

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 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": "1245715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355702400000",
    "number": "1922236454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1951 BENCH RD",
            "address_2": "STE B",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012073",
            "telephone_number": "208-238-1000",
            "fax_number": "208-238-0009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1951 BENCH RD",
            "address_2": "STE B",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012073",
            "telephone_number": "208-238-1000",
            "fax_number": "208-238-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSEN",
        "first_name": "BLAINE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-23",
        "last_updated": "2012-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "MR-1066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

Verify at the official NPI Registry.