Active NPI
Douglas Gross, O.D.
- Optometrist
- Saint Cloud, MN
National Provider Identifier
1033193511
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2083
- Practice address
- 207 County Road 120
Saint Cloud, MN 56303-4872 - Phone
- (320) 202-5985
- Fax
- (320) 202-7890
- NPI assigned
- Nov 30, 2005
- Last updated
- Aug 23, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2083 | MN | Primary |
Addresses
Primary practice location
207 County Road 120
Saint Cloud, MN 56303-4872
Mailing address
207 County Road 120
Saint Cloud, MN 56303-4872
Phone (320) 202-5985
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 078223800 | Medicaid | MN | |
| 410032600 | Other | MN | RAILROAD MEDICARE |
| 82973GR | Other | MN | BLUE CROSS BLUE SHIELD |
| 22-24009 | Other | MN | MEDICA |
| HP27094 | Other | MN | HEALTH PARTNERS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2083 | MN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282521600000",
"number": "1033193511",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "207 COUNTY ROAD 120",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563034872",
"telephone_number": "320-202-5985",
"fax_number": "320-202-7890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "207 COUNTY ROAD 120",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563034872",
"telephone_number": "320-202-5985",
"fax_number": "320-202-7890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROSS",
"first_name": "DOUGLAS",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-30",
"last_updated": "2010-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "2083",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "078223800",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "410032600",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "82973GR",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "22-24009",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP27094",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.