NPIMap

Organization Active NPI

Eye Center of the North Shore, LLC

  • Ophthalmology Physician
  • Salem, MA
National Provider Identifier
1053562330
Registry record updated Aug 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
EYE CENTER OF THE NORTH SHORE, LLC
Practice address
400 Highland Ave
Suite 20
Salem, MA 01970-7003
Phone
(978) 744-1177
Fax
(978) 744-1177
NPI assigned
Oct 6, 2008
Last updated
Aug 12, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2014

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

Authorized official

Name
Dr. Randall Patkin, M.D.NPI 1366447864
Title
President
Phone
(978) 744-1177

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

400 Highland Ave
Suite 20
Salem, MA 01970-7003

Mailing address

400 Highland Ave
Suite 20
Salem, MA 01970-7003
Phone (978) 744-1177

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100602000022 MA Part B Supplier - Clinic/Group Practice 2264561174 Receives reassigned benefits from 13 practitioners
Practice locations: Salem, MA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Eye Center of the North Shore3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • Direct secure messaging: levy.robert.ecpc@direct.partners.masshiway.net
  • Direct secure messaging: patkin.randall.ecpc@direct.partners.masshiway.net
  • Direct secure messaging: ung.jannet.ecpc@direct.partners.masshiway.net

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1223251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407801600000",
    "number": "1053562330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 HIGHLAND AVE",
            "address_2": "SUITE 20",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "019707003",
            "telephone_number": "978-744-1177",
            "fax_number": "978-910-0125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 HIGHLAND AVE",
            "address_2": "SUITE 20",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "019707003",
            "telephone_number": "978-744-1177",
            "fax_number": "978-744-1177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CENTER OF THE NORTH SHORE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-06",
        "last_updated": "2014-08-12",
        "status": "A",
        "authorized_official_last_name": "PATKIN",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-744-1177",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2014; 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.