Organization Active NPI

Jim I Sowders OD PC

  • Optometrist
  • Bedford, IN
National Provider Identifier
1093926438
Registry record updated Feb 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18002066A Issued in IN
Legal business name
JIM I SOWDERS OD PC
Practice address
1615 O St
Bedford, IN 47421-4116
Phone
(812) 275-6155
Fax
(812) 278-9405
NPI assigned
May 25, 2007
Last updated
Feb 14, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2017

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

Authorized official

Name
Dr. Jim I Sowders, OD
Title
President
Phone
(812) 275-6155

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18002066A IN Primary

Addresses

Primary practice location

1615 O St
Bedford, IN 47421-4116

Mailing address

1615 O St
Bedford, IN 47421-4116
Phone (812) 275-6155

Other identifiers 2

IdentifierTypeStateIssuer
000000223127OtherINANTHEM
100166710AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930011270 IN DME Supplier - Physician - Optometrist 4284840257 Practice locations: Bedford, IN
O20120120000064 IN Part B Supplier - Clinic/Group Practice 4284840257 Receives reassigned benefits from 2 practitioners
Practice locations: Bedford, IN

National Provider Directory

National Provider Directory

Locations

1615 O St
Bedford, IN 47421
Phone (812) 275-4714

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487030400000",
    "number": "1093926438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 O ST",
            "city": "BEDFORD",
            "state": "IN",
            "postal_code": "474214116",
            "telephone_number": "812-275-6155",
            "fax_number": "812-278-9405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 O ST",
            "city": "BEDFORD",
            "state": "IN",
            "postal_code": "474214116",
            "telephone_number": "812-275-6155",
            "fax_number": "812-278-9405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIM I SOWDERS OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2017-02-14",
        "status": "A",
        "authorized_official_last_name": "SOWDERS",
        "authorized_official_first_name": "JIM",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "812-275-6155",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002066A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000223127",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100166710A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bedford, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2017; 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.