Individual provider Active NPI

James Leigh Elm, O.D.

  • Optometrist
  • Green Bay, WI
National Provider Identifier
1053479147
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2363 Issued in WI
Practice address
2811 S Oneida St
Green Bay, WI 54304-5748
Phone
(920) 496-9699
Fax
(920) 496-1540
NPI assigned
Dec 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2363 WI Primary

Addresses

Primary practice location

2811 S Oneida St
Green Bay, WI 54304-5748

Mailing address

2811 S Oneida St
Green Bay, WI 54304-5748
Phone (920) 496-9699

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20090413000307 WI Practitioner - Optometry 8628125564 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2363WIMDPeriodontist

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": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053479147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2811 S ONEIDA ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045748",
            "telephone_number": "920-496-9699",
            "fax_number": "920-496-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2811 S ONEIDA ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045748",
            "telephone_number": "920-496-9699",
            "fax_number": "920-496-1540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELM",
        "first_name": "JAMES",
        "middle_name": "LEIGH",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.