Individual provider Active NPI

Lily Jean Sanfilippo, OD

  • Optometrist
  • Gloucester, MA
National Provider Identifier
1205528734
Registry record updated Sep 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5614 Issued in MA
Practice address
214 Eastern Ave Unit 8
Gloucester, MA 01930-1952
Phone
(978) 865-3276
Fax
(978) 865-3288
NPI assigned
May 23, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5614 MA Primary

Addresses

Primary practice location

214 Eastern Ave Unit 8
Gloucester, MA 01930-1952

Mailing address

214 Eastern Ave Unit 8
Gloucester, MA 01930-1952
Phone (978) 865-3276

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
I20231005001408 MA Practitioner - Optometry 9133574502 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

214 Eastern Ave
Unit 8
Gloucester, MA 01930-1952
Phone (978) 865-3276

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5614MAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Sanfilippo Eye Care PLLC Optometrist CurrentSince Oct 1, 2023 Accepting new patients

Locations

214 Eastern Ave
Unit 8
Gloucester, MA 01930
Phone (508) 284-0230

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": "1684800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725321600000",
    "number": "1205528734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 EASTERN AVE UNIT 8",
            "city": "GLOUCESTER",
            "state": "MA",
            "postal_code": "019301952",
            "telephone_number": "978-865-3276",
            "fax_number": "978-865-3288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 EASTERN AVE UNIT 8",
            "city": "GLOUCESTER",
            "state": "MA",
            "postal_code": "019301952",
            "telephone_number": "978-865-3276",
            "fax_number": "978-865-3288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANFILIPPO",
        "first_name": "LILY",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-23",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "5614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gloucester, MA

Sources for this page

Verify at the official NPI Registry.