Active NPI
Samuel Johnson, OD
- Optometrist
- Arcata, CA
National Provider Identifier
1073009114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 33959TLG
- Practice address
- 851 Bayside Rd
Arcata, CA 95521-6769 - Phone
- (707) 822-7641
- NPI assigned
- Jul 2, 2018
- Last updated
- Jul 2, 2018
- Sex
- Male
- Sole proprietor
- No
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 | 33959TLG | CA | Primary |
Addresses
Primary practice location
851 Bayside Rd
Arcata, CA 95521-6769
Mailing address
851 Bayside Rd
Arcata, CA 95521-6769
Phone (707) 822-7641
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Indiana University - School of Optometry, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
851 Bayside Rd
Arcata, CA 95521-6769
Phone (707) 822-7641
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Quality
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33959 | CA | MD | Chiropractor |
| 33959TLG | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Appy Professional Optometric Corporation | Optometrist | Current | Accepting new patients |
Locations
851 Bayside Rd
Ste B
Arcata, CA 95521
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530489600000",
"number": "1073009114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "851 BAYSIDE RD",
"city": "ARCATA",
"state": "CA",
"postal_code": "955216769",
"telephone_number": "707-822-7641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "851 BAYSIDE RD",
"city": "ARCATA",
"state": "CA",
"postal_code": "955216769",
"telephone_number": "707-822-7641"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "SAMUEL",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-02",
"last_updated": "2018-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "33959TLG",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arcata, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.