Active NPI
Jerrad Scott Mills, O.D.
- Optometrist
- Deer Park, TX
National Provider Identifier
1104829464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 6368TG
- Practice address
- 2009 Center St
Deer Park, TX 77536-4161 - Phone
- (281) 479-4570
- Fax
- (281) 479-7895
- NPI assigned
- May 31, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 | 6368TG | TX | Primary |
Addresses
Primary practice location
2009 Center St
Deer Park, TX 77536-4161
Mailing address
2009 Center St
Deer Park, TX 77536-4161
Phone (281) 479-4570
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0042PP | Other | TX | BLUE CROSS BLUE SHIELD |
| 81990Q | Other | TX | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040504000547 | TX | Practitioner - Optometry | 4082602594 | Practice locations: Deer Park, TX |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- University of Houston - College of Optometry, 2002
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
2009 Ctr St
Deer Park, TX 77536-4161
Phone (281) 479-4570
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6368 | TX | MD | Addiction (Substance Use Disorder) Counselor |
| 6368TG | TX | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296432000000",
"number": "1104829464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2009 CENTER ST",
"city": "DEER PARK",
"state": "TX",
"postal_code": "775364161",
"telephone_number": "281-479-4570",
"fax_number": "281-479-7895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2009 CENTER ST",
"city": "DEER PARK",
"state": "TX",
"postal_code": "775364161",
"telephone_number": "281-479-4570",
"fax_number": "281-479-7895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLS",
"first_name": "JERRAD",
"middle_name": "SCOTT",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-05-31",
"last_updated": "2011-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TX",
"license": "6368TG",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0042PP",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "81990Q",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Deer Park, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2011; 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.