NPIMap

Individual provider Active NPI

Jeffrey A. Olson, M.D,

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1952374795
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0000 Issued in IL
Practice address
5215 N California Ave
Chicago, IL 60625-7014
Phone
(773) 878-3627
Fax
(773) 275-5860
NPI assigned
Feb 10, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A75543 CA
Internal Medicine Physician 207R00000X 0000 IL Primary

Addresses

Primary practice location

5215 N California Ave
Chicago, IL 60625-7014

Mailing address

2740 W Foster Ave
LL7
Chicago, IL 60625
Phone (773) 878-8200

Other identifiers 2

IdentifierTypeStateIssuer
036.110640OtherILSTATE LICENSE
336.071295OtherILCDS LIC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jolson21586@direct.northshore.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20080926000634 IL Practitioner - Internal Medicine 7719944156 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
R Franklin University of Med & Sci/Chicago Medical School, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vivek Gupta, M.D., S.C.Group PAC ID 3678668308, 28 clinicians

Practice addresses (Care Compare)

2720 W Division St
Chicago, IL 60622-2853
Phone (773) 772-7858

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.94 of 100Reported as individual
Quality
85
Improvement activities
40
Cost
37.3

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0000ILMDClinical Psychologist
A75543CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Swedish Covenant Management Services, Inc. Internal Medicine CurrentSince Feb 22, 2016 Accepting new patients
Swedish Covenant Management Services, Inc CurrentSince Feb 22, 2016 Accepting new patients
Vivek Gupta, M.D., S.C. Internal Medicine CurrentSince Jun 30, 2022 Accepting new patients
North Shore Physicians Group, LLC Internal Medicine Past Accepting new patients
North Shore Physicians Group, LLC Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

5215 N California Ave
Ste 603
Chicago, IL 60625
Phone (773) 275-1020

5140 N California Ave
Ste 780
Chicago, IL 60625
Phone (773) 784-5140

2720 W Division St
Chicago, IL 60622
Phone (773) 523-8600

4646 N Marine Dr
Chicago, IL 60640
Phone (773) 564-5102

5145 N California Ave
Chicago, IL 60625
Phone (773) 989-3800

Organizations & group practices 6

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 12

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": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1952374795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2740 W FOSTER AVE",
            "address_2": "LL7",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60625",
            "telephone_number": "773-878-8200",
            "fax_number": "773-293-4197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5215 N CALIFORNIA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606257014",
            "telephone_number": "773-878-3627",
            "fax_number": "773-275-5860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "JEFFREY",
        "middle_name": "A.",
        "credential": "M.D,",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-10",
        "last_updated": "2023-03-07",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A75543",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "0000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036.110640",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDS LIC",
            "identifier": "336.071295",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jolson21586@direct.northshore.org",
            "affiliation": "N",
            "address_1": "5215 N California Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606257014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.