Individual provider Active NPI

Peter Lemkin, O.D.

  • Optometrist
  • Johnson City, TN
National Provider Identifier
1194783167
Registry record updated Jan 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD2144 Issued in TN
Practice address
110 Med Tech Pkwy
Suite 1
Johnson City, TN 37604-4004
Phone
(423) 929-2111
Fax
(423) 929-0497
NPI assigned
May 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OD2144 TN Primary

Addresses

Primary practice location

110 Med Tech Pkwy
Suite 1
Johnson City, TN 37604-4004

Mailing address

110 Med Tech Pkwy
Suite 1
Johnson City, TN 37604-4004
Phone (423) 929-2111

Other identifiers 1

IdentifierTypeStateIssuer
3944958MedicaidTN

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100520000002 TN Practitioner - Optometry 8022147644 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Johnson City Eye Clinic PCGroup PAC ID 3375448681, 11 clinicians

Practice addresses (Care Compare)

110 Med Tech Pkwy
Suite 1
Johnson City, TN 37604-4004
Phone (423) 929-2111

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Johnson City Eye Clinic PC CurrentSince Jan 7, 2002 Accepting new patients

Locations

193 Franklin Dr
Ste A
Blountville, TN 37617

225 Midway Medical Park
Bristol, TN 37620
Phone (423) 797-4555

321 Midway Medical Park
Bristol, TN 37620
Phone 42392921110

110 Med Tech Pkwy
Johnson City, TN 37604
Phone (423) 722-0340

110 Med Tech Pkwy
Ste 1
Johnson City, TN 37604
Phone 42372203603507

Organizations & group practices 1

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": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201737600000",
    "number": "1194783167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 MED TECH PKWY",
            "address_2": "SUITE 1",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044004",
            "telephone_number": "423-929-2111",
            "fax_number": "423-929-0497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 MED TECH PKWY",
            "address_2": "SUITE 1",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044004",
            "telephone_number": "423-929-2111",
            "fax_number": "423-929-0497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEMKIN",
        "first_name": "PETER",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2008-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "OD2144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3944958",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.