Individual provider Active NPI

Kurtis Roy Zimmerman, OD

  • Optometrist
  • Worcester, MA
National Provider Identifier
1053434217
Registry record updated Sep 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4582 Issued in MA
Practice address
5 Neponset St
Worcester, MA 01606-2714
Phone
(508) 856-9599
Fax
(508) 854-4998
NPI assigned
Apr 10, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4582 MA Primary

Addresses

Primary practice location

5 Neponset St
Worcester, MA 01606-2714

Mailing address

5 Neponset St FL Street12
Worcester, MA 01606-2714
Phone (508) 856-9599

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20070522000082 MA Practitioner - Optometry 3476595422 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Reliant Medical Group IncGroup PAC ID 5597755322, 638 clinicians

Practice addresses (Care Compare)

5 Neponset St
Worcesteer, MA 01606-2714
Phone (508) 595-2300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Reliant Medical Group, Inc CurrentSince Apr 30, 2007 Accepting new patients
Reliant Medical Group, Inc Past Accepting new patients

Locations

5 Neponset St
#12
Worcester, MA 01606
Phone (508) 595-2300

5 Neponset St
Worcester, MA 01606
Phone (508) 595-2300

630 Plantation St
#12
Worcester, MA 01605

Interoperability endpoints

  • Direct secure messaging: kurtis.zimmerman.npi1053434217.reliant@direct.optumcare.masshiway.net

Organizations & group practices 2

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": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538006400000",
    "number": "1053434217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 NEPONSET ST FL STREET12",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016062714",
            "telephone_number": "508-856-9599",
            "fax_number": "508-854-4998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 NEPONSET ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016062714",
            "telephone_number": "508-856-9599",
            "fax_number": "508-854-4998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIMMERMAN",
        "first_name": "KURTIS",
        "middle_name": "ROY",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-10",
        "last_updated": "2018-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.