Individual provider Active NPI

Ardith Renee Pagan, O.D.

  • Optometrist
  • Austin, TX
National Provider Identifier
1013086362
Registry record updated Apr 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
6003T Issued in TX
Practice address
11005 Burnet Rd
Suite 120
Austin, TX 78758-4444
Phone
(512) 596-2020
Fax
(512) 596-3937
NPI assigned
Nov 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 6003T TX Primary

Addresses

Primary practice location

11005 Burnet Rd
Suite 120
Austin, TX 78758-4444

Mailing address

11005 Burnet Rd
Suite 120
Austin, TX 78758-4444
Phone (512) 596-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160707001504 TX Practitioner - Optometry 3072805324 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Temple Optometrists PCGroup PAC ID 8022004597, 4 clinicians

Practice addresses (Care Compare)

2806 S W S Young Dr a
Central Killeen Vision Source
Killeen, TX 76542-2011
Phone (254) 634-4800

2910 Market Loop
Temple, TX 76502-1855
Phone (254) 778-6165

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6003TTXMDOptometrist

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460505600000",
    "number": "1013086362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11005 BURNET RD",
            "address_2": "SUITE 120",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787584444",
            "telephone_number": "512-596-2020",
            "fax_number": "512-596-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11005 BURNET RD",
            "address_2": "SUITE 120",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787584444",
            "telephone_number": "512-596-2020",
            "fax_number": "512-596-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAGAN",
        "first_name": "ARDITH",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-08",
        "last_updated": "2016-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "6003T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.