NPIMap

Organization Active NPI

Marianas Eye Institute Inc

  • Ophthalmology Physician
  • Saipan, MP
National Provider Identifier
1023168010
Registry record updated Jul 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
0102 Issued in MP
Legal business name
MARIANAS EYE INSTITUTE INC
Practice address
503900 Mooty
13 Fishermen Beachroad, Garapan
Saipan, MP 96950-3900
Phone
(670) 235-9090
Fax
(670) 235-9091
NPI assigned
Jan 11, 2007
Last updated
Jul 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2019

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

Authorized official

Name
Dr. Koorosh David Khorram, M.D.
Title
President
Phone
(670) 235-9090

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 0015 MP
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X 0102 MP Primary

Addresses

Primary practice location

503900 Mooty
13 Fishermen Beachroad, Garapan
Saipan, MP 96950-3900

Mailing address

PO Box 503900
Saipan, MP 96950-3900
Phone (670) 235-9090

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Saipan Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MP

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040311000670 MP Part B Supplier - Clinic/Group Practice 1052200821 Receives reassigned benefits from 12 practitioners
Practice locations: Saipan, MP

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: jbernardino@marianaseye.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562803200000",
    "number": "1023168010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 503900",
            "city": "SAIPAN",
            "state": "MP",
            "postal_code": "969503900",
            "telephone_number": "670-235-9090",
            "fax_number": "670-235-9091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503900 MOOTY",
            "address_2": "13 FISHERMEN BEACHROAD, GARAPAN",
            "city": "SAIPAN",
            "state": "MP",
            "postal_code": "969503900",
            "telephone_number": "670-235-9090",
            "fax_number": "670-235-9091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIANAS EYE INSTITUTE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2019-07-11",
        "status": "A",
        "authorized_official_last_name": "KHORRAM",
        "authorized_official_first_name": "KOOROSH",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "670-235-9090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MP",
            "license": "0015",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "MP",
            "license": "0102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Saipan",
            "affiliation": "N",
            "endpointDescription": "direct submission",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "503900 Mooty",
            "address_2": "13 Fishermen Beachroad, Garapan",
            "city": "Saipan",
            "state": "MP",
            "country_code": "US",
            "postal_code": "969503900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saipan, MP

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.