Kelly G Ross, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2485 Issued in AR

Practice address

1014 W Main St
Walnut Ridge, AR 72476-1004

Phone

(870) 886-2632

Fax

(870) 886-1514

NPI assigned

Jun 22, 2006

Last updated

Dec 29, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

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

Specialty

Optometry

Education

Southern College of Optometry, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kelly G Ross OD PAGroup PAC ID 7214982321, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Kelly G Ross OD PA

  dba ross eye care center

  • Optometrist
  • Walnut Ridge, AR
  • NPI 1982760955
  Medicare reassignment Care Compare group Authorized official
• Southern Eye Associates, LTD

  • Optometrist
  • Walnut Ridge, AR
  • NPI 1215025119
  NPD (past)

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1230508800000",
    "number": "1073549200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 349",
            "city": "WALNUT RIDGE",
            "state": "AR",
            "postal_code": "724760349",
            "telephone_number": "870-886-2632",
            "fax_number": "870-886-1514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 W MAIN ST",
            "city": "WALNUT RIDGE",
            "state": "AR",
            "postal_code": "724761004",
            "telephone_number": "870-886-2632",
            "fax_number": "870-886-1514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "KELLY",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-22",
        "last_updated": "2008-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137089722",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Justin M Robertson
• Donald C Roe, D.C.
• Rogers Pharmacy Inc (Rogers Pharmacy)
• Rogers Pharmacy Inc
• Marcus Lee Rose, PTA
• Dion Rowlett, MHPP
• S & R Clinic, PA (Troxel Medical Clinic)
• Robert L Shackelford, D.C.
• Journee Janelle Shaw
• Shme, Inc

• Optometrist in Walnut Ridge, AR
• Providers in Walnut Ridge, AR by specialty
• Optometrist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2008; 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.

Verify at the official NPI Registry.