Gregory D Loose, OD
Individual provider Active NPI Optometrist · Wiggins, MS
NPI 1013096825 · NPPES record last updated Feb 26, 2008
Key facts
- NPI
- 1013096825
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 758 (MS)
- Practice address
- 1113 Central Ave E
Wiggins, MS 39577-9605 - Phone
- (601) 928-3914
- Fax
- (601) 928-2207
- NPI assigned
- Nov 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern College of Optometry, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- The Vision Center PA
Practice addresses (Care Compare)
1113 Central Ave E
Wiggins, MS 39577-9605
Phone (601) 928-3914
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 80 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070510000425 | MS | Practitioner - Optometry | 3173629904 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles (1 of 11)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Vision Center PA | Optometrist | Current |
Accepting new patients |
Locations
727 Winter St
Lucedale, MS 39452
Phone (601) 947-2913
747 Winter St
Lucedale, MS 39452
1113 Central Ave E
Wiggins, MS 39577
Phone (601) 928-3914
Networks
- TN PPO C-SNP
- MS PPO D-SNP
- MS PPO
- MS PPO C-SNP
- AL HMO
- TN PPO
- devoted network organization-14bfd35d-d818-4696-813b-340339e464ef
- AL HMO D-SNP
- devoted network organization-d5084670-562f-408b-b100-22a1a4ef4d82
- devoted network organization-25ba88d3-d0a6-4213-84f1-eef6f2b59f68
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 758 | MS | Yes |
Addresses
Primary practice location
1113 Central Ave E
Wiggins, MS 39577-9605
Mailing address
1113 Central Ave E
Wiggins, MS 39577-9605
Phone (601) 928-3914
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01374059 | Medicaid | MS |
Other providers in Wiggins, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.