NPIMap

Organization Active NPI

Ivory a. Kinslow, Mdpa

  • Optometrist
  • Magnolia, AR
National Provider Identifier
1124684923
Registry record updated May 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
IVORY A. KINSLOW, MDPA
Practice address
220 N Pine
Magnolia, AR 71753-2905
Phone
(870) 234-4444
NPI assigned
May 16, 2019
Last updated
May 16, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
IVORY A. KINSLOW, MDPAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 16, 2019

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

Authorized official

Name
Sharon L Winn
Title
Ceo
Phone
(573) 718-4808

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary
Ophthalmology Physician 207W00000X NU

Addresses

Primary practice location

220 N Pine
Magnolia, AR 71753-2905

Mailing address

PO Box 11090
El Dorado, AR 71730-0031
Phone (870) 862-2340

Other identifiers 1

IdentifierTypeStateIssuer
2124OtherAROPTOMETRIST LICENSE

Other names 1

  • Ivory A. Kinslow, MDPA MAG Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180625001073 AR DME Supplier - Physician - OptometristDME Supplier - Physician - Ophthalmology 3678713054 Practice locations: El Dorado, AR

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Ivory a Kinslow Mdpa3 organizations share this tax ID, including this one
Part of
Ivory a Kinslow Mdpa

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 7

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": "1557964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557964800000",
    "number": "1124684923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11090",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717300031",
            "telephone_number": "870-862-2340",
            "fax_number": "870-863-4951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 N PINE",
            "city": "MAGNOLIA",
            "state": "AR",
            "postal_code": "717532905",
            "telephone_number": "870-234-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVORY A. KINSLOW, MDPA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IVORY A. KINSLOW, MDPA",
        "enumeration_date": "2019-05-16",
        "last_updated": "2019-05-16",
        "status": "A",
        "authorized_official_last_name": "WINN",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-718-4808"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTOMETRIST LICENSE",
            "identifier": "2124",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ivory A. Kinslow, MDPA MAG",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Magnolia, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2019; 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.