Individual provider Active NPI

Bennett David McAllister, O.D.

  • Optometrist
  • Pomona, CA
National Provider Identifier
1124057351
Registry record updated Oct 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
7275T Issued in CA
Practice address
795 E 2ND St
Suite 2
Pomona, CA 91766-2007
Phone
(909) 706-3899
Fax
(909) 469-8640
NPI assigned
Jul 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 7275T CA Primary
Low Vision Rehabilitation Optometrist 152WL0500X OPT7275TPG CA
Pediatric Optometrist 152WP0200X OPT7275TPG CA

Addresses

Primary practice location

795 E 2ND St
Suite 2
Pomona, CA 91766-2007

Mailing address

795 E 2ND St
Suite 2
Pomona, CA 91766-2007
Phone (909) 469-8773

Other identifiers 1

IdentifierTypeStateIssuer
DL049ZOtherCAMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20080123000515 CA Practitioner - Optometry 6709968233 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University Alabama Birmingham - School of Optometry, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Western University of Health SciencesGroup PAC ID 0648208991, 50 clinicians

Practice addresses (Care Compare)

795 E 2ND St
Pomona, CA 91766-2007
Phone (909) 469-8673

Merit-based Incentive Payment System (MIPS)

Final score
86.49 of 100Reported as group
Quality
68.78
Improvement activities
40
Cost
78.85

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7275TCAMDOptometrist
OPT7275TPGCAMDLow Vision Rehabilitation Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Western University of Health Sciences Optometrist CurrentSince Sep 1, 2010 Accepting new patients
Western University of Health Sciences Current Accepting new patients
Western University of Health Sciences CurrentSince Sep 1, 2010 Accepting new patients
James R. Dallas, O.D. Optometrist PastSince Sep 1, 2010 Accepting new patients

Locations

795 E 2nd St
Ste 2
Pomona, CA 91766
Phone (909) 469-8673

795 E 2nd St
Ste 5
Pomona, CA 91766
Phone (909) 706-3877

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: bmcallister195836@direct.ochin.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477353600000",
    "number": "1124057351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "795 E 2ND ST",
            "address_2": "SUITE 2",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917662007",
            "telephone_number": "909-469-8773",
            "fax_number": "909-469-5228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "795 E 2ND ST",
            "address_2": "SUITE 2",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917662007",
            "telephone_number": "909-706-3899",
            "fax_number": "909-469-8640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCALLISTER",
        "first_name": "BENNETT",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-01",
        "last_updated": "2016-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "7275T",
            "primary": true
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "CA",
            "license": "OPT7275TPG",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "CA",
            "license": "OPT7275TPG",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "DL049Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.