Khrys Gates, OD
Individual provider Active NPI Optometrist · Polacca, AZ
NPI 1073896825 · NPPES record last updated May 9, 2012
Key facts
- NPI
- 1073896825
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2845 (CO)
- Practice address
- Hwy 264 Mile Post 388
Polacca, AZ 86042-4000 - Phone
- (928) 737-6003
- Fax
- (928) 737-6080
- NPI assigned
- Sep 27, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- University of Missouri St Louis - School of Optometry, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Yakama Indian Health Center
Practice addresses (Care Compare)
401 Buster Rd
Toppenish, WA 98948-9792
Phone (509) 865-1705
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111101000327 | TX | Practitioner - Optometry | 7911170352 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2845 | CO | MD | Optometrist |
| 2026 | AZ | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergency Medical & Surgical Specialists of Colorado LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2845 | CO | Yes |
Addresses
Primary practice location
Hwy 264 Mile Post 388
Polacca, AZ 86042-4000
Mailing address
PO Box 4000
Polacca, AZ 86042-4000
Phone (928) 737-6003
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020529 | Medicaid | AZ |
Other providers in Polacca, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.