Individual provider Active NPI

Kristy Nguyen

  • Optometrist
  • Concord, CA
National Provider Identifier
1194418418
Registry record updated Jun 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
35447 Issued in CA
Practice address
917 Autumn Brook PL
Concord, CA 94518-3332
Phone
(209) 612-8117
NPI assigned
Jun 1, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 35447 CA Primary

Addresses

Primary practice location

917 Autumn Brook PL
Concord, CA 94518-3332

Mailing address

917 Autumn Brook PL
Concord, CA 94518-3332

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
I20240820002976 MA Practitioner - Optometry 9032657192 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atrius Health IncGroup PAC ID 4789588641, 1,214 clinicians

Practice addresses (Care Compare)

291 Independence Dr
Chestnut Hill, MA 02467-3628
Phone (617) 325-2800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
35447CAMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Atrius Health, Inc. CurrentSince Sep 1, 2024 Accepting new patients
Atrius Health, Inc. CurrentSince Sep 1, 2024 Accepting new patients
Atrius Health, Inc. Optometrist Current Accepting new patients
Atrius Health, Inc. Past Accepting new patients

Locations

133 Brookline Ave
Boston, MA 02215
Phone (617) 421-1000

291 Independence Dr
Chestnut Hill, MA 02467
Phone (617) 325-2800

Interoperability endpoints

  • Direct secure messaging: knguyenod383739@direct.atrius.masshiway.net

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": "1685577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685577600000",
    "number": "1194418418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "917 AUTUMN BROOK PL",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945183332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 AUTUMN BROOK PL",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945183332",
            "telephone_number": "209-612-8117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "KRISTY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-01",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "35447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, CA

Sources for this page

Verify at the official NPI Registry.