Individual provider Active NPI

Daniel Edward Bausch, O.D.

  • Optometrist
  • Springfield, MA
National Provider Identifier
1184633547
Registry record updated Aug 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2337 Issued in MA
Practice address
289 Bridge St
Springfield, MA 01103-1409
Phone
(413) 734-8366
Fax
(413) 739-5596
NPI assigned
Aug 5, 2006
Last updated
Aug 6, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2337 MA Primary

Addresses

Primary practice location

289 Bridge St
Springfield, MA 01103-1409

Mailing address

289 Bridge St
Springfield, MA 01103-1409
Phone (413) 734-8366

Other identifiers 2

IdentifierTypeStateIssuer
0326836MedicaidMA
54588OtherMAUPIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20050506000042 MA Practitioner - Optometry 0749220093 Practice locations: Springfield, MA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11 Wilbraham Rd
Springfield, MA 01109-3161
Phone (413) 794-9781

11 Wilbraham Rd
Springfield, MA 01109-3165

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375747200000",
    "number": "1184633547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "289 BRIDGE ST",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011031409",
            "telephone_number": "413-734-8366",
            "fax_number": "413-739-5596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "289 BRIDGE ST",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011031409",
            "telephone_number": "413-734-8366",
            "fax_number": "413-739-5596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUSCH",
        "first_name": "DANIEL",
        "middle_name": "EDWARD",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2013-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "2337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0326836",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "54588",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MA

Sources for this page

Verify at the official NPI Registry.