Bradley D Martinson, OD – Optometrist in Godfrey, IL

Key facts

NPI: 1174774079
Entity type: Individual (NPI type 1)
Primary specialty: Optometrist 152W00000X
License: 046010101 (IL)
Practice address: 3300 Godfrey Rd
Godfrey, IL 62035
Phone: (618) 466-8787
Fax: (618) 466-4703
NPI assigned: Oct 9, 2008
Sex: Male
Sole proprietor: No

Organizations & group practices 2

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.

Rose Optical, Inc. Optometrist · Godfrey, IL · NPI 1669444063

Medicare reassignment Care Compare group NPD IL · OPTOMETRIST
Illini Optometric PC Optometrist · Godfrey, IL · NPI 1780850032

NPD OPTOMETRIST

Medicare Care Compare profile

Specialty: Optometry
Education: University of Missouri St Louis - School of Optometry, 2008
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Rose Optical, Inc. (4 clinicians)

Practice addresses (Care Compare)

3300 Godfrey Rd
Godfrey, IL 62035-2558
Phone (618) 466-8787

Medicare participation

Medicare fee-for-service enrollment: Enrolled in IL
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20081208000391	IL	Practitioner - Optometry	5193886273	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

Practice roles

Organization	Specialty	Status	New patients
Rose Optical, Inc.	Optometrist	Current since Dec 1, 2008	Accepting new patients
Illini Optometric PC	Optometrist	Current since Jun 1, 2011	Accepting new patients

Locations

3300 Godfrey Rd
Godfrey, IL 62035
Phone (618) 466-8787

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Optometrist	152W00000X	046010101	IL	Yes

Addresses

Primary practice location

3300 Godfrey Rd
Godfrey, IL 62035

Mailing address

PO Box 5040
Godfrey, IL 62035
Phone (618) 466-8787

Other identifiers

Identifier	Type	State	Issuer
P00880071	Other	IL	RAILROAD MEDICARE
046010101	Medicaid	IL

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 25, 2011.

{
    "created_epoch": "1223510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303689600000",
    "number": "1174774079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5040",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "62035",
            "telephone_number": "618-466-8787",
            "fax_number": "618-466-4703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 GODFREY RD",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "62035",
            "telephone_number": "618-466-8787",
            "fax_number": "618-466-4703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINSON",
        "first_name": "BRADLEY",
        "middle_name": "D",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-09",
        "last_updated": "2011-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00880071",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046010101",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Godfrey, IL

All providers in Godfrey, IL · Optometrist in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2011. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (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.