Physician Compare National (NPI:1235273616)

HEALTHCARE PROVIDER: DOUGLAS CRAIG OLSEN M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1235273616
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4880582907
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110228000860
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	OLSEN
	Individual professional last name
Provider First Name	DOUGLAS
	Individual professional first name
Provider Middle Name	CRAIG
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF HAWAII JOHN A. BURNS SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1996
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	670 PONAHAWAI ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 208
	Group Practice or individual's line 2 address
City	HILO
	Group Practice or individual's city
State	HI
	Group Practice or individual's state
Zip Code	967207830
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	120005
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HILO MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	121301
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	KAU HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y