Active NPI
Samuel Harvey Horner III, O.D.
- Corneal and Contact Management Optometrist
- Cleveland, TN
National Provider Identifier
1164412102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Corneal and Contact Management Optometrist
- License
- 000963
- Practice address
- 40 2ND St NW
Cleveland, TN 37311-5009 - Phone
- (423) 476-5341
- Fax
- (423) 472-0321
- NPI assigned
- Oct 21, 2005
- Last updated
- Sep 23, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Corneal and Contact Management Optometrist | 152WC0802X | 000963 | TN | Primary |
Addresses
Primary practice location
40 2ND St NW
Cleveland, TN 37311-5009
Mailing address
40 2ND St NW
Cleveland, TN 37311-5009
Phone (423) 476-5341
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 113503 | Medicaid | TN | |
| 113503 | Other | TN | BLUE CROSS BLUE SHIELD |
| 602003553 | Other | TN | CARITEN SR. |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- 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 |
|---|---|---|---|---|
| I20071105000454 | TN | Practitioner - Optometry | 7113014309 | Practice locations: Cleveland, TN |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Pacific University - College of Optometry, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
40 2ND St NW
Cleveland, TN 37311-5009
Phone (423) 476-5341
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000963 | TN | MD | Corneal and Contact Management Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442966400000",
"number": "1164412102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 2ND ST NW",
"city": "CLEVELAND",
"state": "TN",
"postal_code": "373115009",
"telephone_number": "423-476-5341",
"fax_number": "423-472-0321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 2ND ST NW",
"city": "CLEVELAND",
"state": "TN",
"postal_code": "373115009",
"telephone_number": "423-476-5341",
"fax_number": "423-472-0321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HORNER",
"first_name": "SAMUEL",
"middle_name": "HARVEY",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-21",
"last_updated": "2015-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "TN",
"license": "000963",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "113503",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "113503",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARITEN SR.",
"identifier": "602003553",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2015; 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.