Kenneth Trevor Shealy, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT003252 Issued in GA

Practice address

1803 Old Ocilla Rd
Tifton, GA 31794-1617

Phone

(229) 386-2181

Fax

(229) 386-2193

NPI assigned

Aug 6, 2020

Sex

Male

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 GA

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, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tift Regional Health System IncGroup PAC ID 2062745169, 294 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

81.02 of 100Reported as group

Quality

57.87

Promoting interoperability

100

Improvement activities

40

Cost

75.97

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ks@tiftregionalophthalmology.direct.eyemdemr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tift Regional Health System Inc

  • Family Medicine Physician
  • Tifton, GA
  • NPI 1881203305
  Medicare reassignment Care Compare group NPD
• Fitzgerald Family Eyecare, P.C.

  • Optometrist
  • Douglas, GA
  • NPI 1114938727
  Medicare reassignment NPD
• Tift Regional Health System Inc

  • Clinic/Center
  • Tifton, GA
  • NPI 1003980996
  NPD
• Tift Regional Health System Inc

  • Pediatrics Physician
  • Tifton, GA
  • NPI 1366765166
  NPD
• Tift Regional Health System Inc

  • Ophthalmology Physician
  • Tifton, GA
  • NPI 1790280857
  NPD (past)

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

{
    "created_epoch": "1596672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724371200000",
    "number": "1104436922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1803 OLD OCILLA RD",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317941617",
            "telephone_number": "229-386-2181",
            "fax_number": "229-386-2193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1803 OLD OCILLA RD",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317941617",
            "telephone_number": "229-386-2181",
            "fax_number": "229-386-2193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEALY",
        "first_name": "KENNETH",
        "middle_name": "TREVOR",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-06",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT003252",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTOMETRY LICENSE",
            "identifier": "OPT003252",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda Nhu Selph, PHARMD
• Muhammad Asad Shabbir
• Apurva Narendra Shah, M.D.
• Qamar U Shaikh, M.D.
• Erin Mozingo Shealy, OD
• Megan Shipp
• Thomas L Shoup, PAC
• Angjelin Shtjefni
• Macy Sigmon
• Robert Scott Simmons, D.C.

• Optometrist in Tifton, GA
• Providers in Tifton, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; 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.