Individual provider Active NPI

Richard K Olsen, MD

  • Internal Medicine Physician
  • Provo, UT
National Provider Identifier
1932157138
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2743161205 Issued in UT
Practice address
1055 N 500 W
Suite 212
Provo, UT 84604-3305
Phone
(801) 374-2362
Fax
(801) 429-8196
NPI assigned
May 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2743161205 UT Primary

Addresses

Primary practice location

1055 N 500 W
Suite 212
Provo, UT 84604-3305

Mailing address

1055 N 500 W
Attn: Credentialing
Provo, UT 84604-3305
Phone (801) 354-8225

Other identifiers 5

IdentifierTypeStateIssuer
110116385OtherUTPALMETTO GBA
107008142101OtherUTIHC HEALTHPLANS
220734OtherUTDMBA
35882OtherUTPEHP
QMAF03080OtherUTALTIUS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address medreview@reverehealth.com Revere Health PC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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 1

Enrollment IDStateProvider typePAC IDDetails
I20050323001452 UT Practitioner - Internal Medicine 7911953849 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Utah School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Revere Health PCGroup PAC ID 7517868508, 407 clinicians

Practice addresses (Care Compare)

1055 N 500
Provo, UT 84604-3305
Phone (801) 429-8000

Hospital & facility affiliations

  • Aspen Ridge Home Health Home health agency, Murray, UT, CCN 467220
  • Intermountain Homecare Home Health Salt Lake Home health agency, South Jordan, UT, CCN 467030
  • Intermountain Health Utah Valley Hospital Hospital, Provo, UT, CCN 460001
  • American Fork Hospital Hospital, American Fork, UT, CCN 460023

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2743161205UTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Revere Health PC CurrentSince Aug 1, 1995 Accepting new patients
Revere Health PC CurrentSince Aug 1, 1995 Accepting new patients

Locations

1175 E 50 S
American Fork, UT 84003
Phone (719) 492-5994

1152 E 200 N
American Fork, UT 84003
Phone (801) 772-0698

4095 E Pony Express Pkwy
Ste 1
Eagle Mountain, UT 84005
Phone (801) 429-8037

3000 N Triumph Blvd
Lehi, UT 84043
Phone (385) 345-3000

700 W 800 N
Ste 200
Orem, UT 84057
Phone (801) 229-2229

15 S 1000 E
Payson, UT 84651
Phone (888) 883-6407

97 Professional Way
Payson, UT 84651
Phone (801) 465-4896

1120 E 100 N
Ste 1
Payson, UT 84651
Phone (801) 465-4813

1886 W 800 N
Pleasant Grv, UT 84062
Phone (801) 756-5288

1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000

1055 N 500 W
Ste 212
Provo, UT 84604
Phone (801) 374-2362

555 W State Road 164
Salem, UT 84653
Phone (801) 465-4896

Interoperability endpoints

  • Direct secure messaging: richardolsen@cuccu.allscriptsdirect.net

Organizations & group practices 2

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.

Hospital & facility affiliations 6

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": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1932157138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "ATTN: CREDENTIALING",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "SUITE 212",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-374-2362",
            "fax_number": "801-429-8196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSEN",
        "first_name": "RICHARD",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2023-11-27",
        "certification_date": "2020-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "UT",
            "license": "2743161205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "110116385",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHC HEALTHPLANS",
            "identifier": "107008142101",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "220734",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "35882",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALTIUS",
            "identifier": "QMAF03080",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medreview@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Revere Health PC",
            "address_1": "1055 N 500 W",
            "address_2": "Suite 212",
            "city": "Provo",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846043305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.