NPIMap

Individual provider Active NPI

Jacob B Olson

  • Family Medicine Physician
  • Cookeville, TN
National Provider Identifier
1922582873
Registry record updated Oct 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
PA03726 Issued in TN
Practice address
105 S Willow Ave
Cookeville, TN 38501-4667
Phone
(931) 526-9518
Fax
(931) 372-0087
NPI assigned
Sep 17, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 10, 2022

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 PA03726 TN Primary

Addresses

Primary practice location

105 S Willow Ave
Cookeville, TN 38501-4667

Mailing address

105 S Willow Ave
Cookeville, TN 38501-4667
Phone (931) 526-9518

Other practice location 1

133 Churchill Dr Ste A
Sparta, TN 38583-1500
Phone (931) 836-3262

Other identifiers 1

IdentifierTypeStateIssuer
Q047209MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20200418000236 TN Practitioner - Physician Assistant 4486082625 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Campbell Clinic, PC 229 clinicians

Practice addresses (Care Compare)

105 S Willow Ave
Cookeville, TN 38501-4667
Phone (931) 526-9518

1400 S Germantown Rd
Germantown, TN 38138-2205
Phone (901) 759-3100

335 W Spring St
Cookeville, TN 38501-3125
Phone (931) 526-9518

Hospital & facility affiliations

  • Cookeville Regional Medical Center Hospital, Cookeville, TN, CCN 440059
  • Cumberland Medical Center Hospital, Crossville, TN, CCN 440009

Merit-based Incentive Payment System (MIPS)

Final score
75.09 of 100Reported as group
Quality
50.47
Promoting interoperability
99
Improvement activities
40
Cost
67.33

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Campbell Clinic PC CurrentSince Aug 1, 2022 Accepting new patients
Titan Orthopedics of Memphis, PLLC CurrentSince Aug 1, 2022 Accepting new patients
Campbell Clinic Past Accepting new patients

Locations

1900 W Poplar Ave
Collierville, TN 38017
Phone (901) 759-5491

105 S Willow Ave
Cookeville, TN 38501
Phone (931) 372-7716

105 S Willow Ave
Ste 100
Cookeville, TN 38501
Phone (931) 267-4929

335 W Spring St
Cookeville, TN 38501
Phone (931) 303-0446

35 Taylor Ave
Crossville, TN 38555
Phone (865) 483-8478

1400 S Germantown Rd
Memphis, TN 38138
Phone (901) 759-3111

Interoperability endpoints

  • Direct secure messaging: jacob.olson.1@1366.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/14704/brand/1/csg/1/fhir/r4
  • FHIR API: https://api.platform.athenahealth.com/1366/brand/1/csg/1/fhir/r4

Organizations & group practices 26

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 26

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": "1537142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1922582873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 S WILLOW AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385014667",
            "telephone_number": "931-526-9518",
            "fax_number": "931-372-0087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S WILLOW AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385014667",
            "telephone_number": "931-526-9518",
            "fax_number": "931-372-0087"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "133 Churchill Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Sparta",
            "state": "TN",
            "postal_code": "385831500",
            "country_code": "US",
            "telephone_number": "931-836-3262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLSON",
        "first_name": "JACOB",
        "middle_name": "B",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-09-17",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "PA03726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q047209",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cookeville, TN

Sources for this page

Verify at the official NPI Registry.