Olivia Lee Rivera, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601006892 Issued in MI

Practice address

25 Michigan St NE Ste 6100
Grand Rapids, MI 49503-2561

Phone

(616) 267-7900

NPI assigned

Jan 13, 2014

Last updated

Jun 29, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Olivia Lee Johnson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: orivera102098@epic00.shdirect.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593388800000",
    "number": "1952723892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1468 FAIRWOOD CT SE",
            "city": "CALEDONIA",
            "state": "MI",
            "postal_code": "493169738",
            "telephone_number": "616-204-7475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 MICHIGAN ST NE STE 6100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032561",
            "telephone_number": "616-267-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "OLIVIA",
        "middle_name": "LEE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-13",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "OLIVIA",
            "last_name": "JOHNSON",
            "middle_name": "LEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• River Valley Orthopedics, P.C.
• River Valley Orthopedics, P.C.
• Betzaida Rivera-Ash, BCABA, LABA
• Maria C Rivera-Ayers C Rivera-Ayers
• Jennifer Rivera
• Ronald Christian Rivera, LMSW
• Samantha Jean Rivera, M.S. CCC-SLP
• John Rivero
• Riverside Psychiatric Services PLLC
• Riverwood Family Medicine PC

• Physician Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.