Jimmy H Elam, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2189 Issued in MO

Practice address

2511 N Westwood Blvd
Poplar Bluff, MO 63901-2338

Phone

(573) 686-5866

Fax

(618) 997-6250

NPI assigned

Aug 24, 2005

Last updated

Dec 13, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dr. Mark Lynn & Associates, PLLC

  dba Visionworks Doctors of Optometry

  • Optometrist
  • Franklin, TN
  • NPI 1194739490
  Medicare reassignment NPD
• Meyer Eye Group PLC

  • Ophthalmology Physician
  • Memphis, TN
  • NPI 1669427886
  NPD (past)
• The Eye Doctor LLC

  • Optometrist
  • Memphis, TN
  • NPI 1376793653
  NPD (past)

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323734400000",
    "number": "1194718379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1178",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629597678",
            "telephone_number": "618-993-5686",
            "fax_number": "618-997-6250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2511 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012338",
            "telephone_number": "573-686-5866",
            "fax_number": "618-997-6250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELAM",
        "first_name": "JIMMY",
        "middle_name": "H",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-24",
        "last_updated": "2011-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194718379",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Michelle Edmonds
• Jessica Marie Edwards
• Rebecca Ann Eggers
• Nicole Renee Ehinger, FNP
• Milton R Eichmann, MD
• Courtney Elder
• Michelle Elder
• Elite Obstetrics and Gynecology LLC
• Cynthia J Elliott, LCSW
• John Quincy Elliott, DO

• Optometrist in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.