Willie F Ross Jr., O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

755DT Issued in KY

Practice address

22 Executive Dr
Tompkinsville, KY 42167-7478

Phone

(270) 487-5741

Fax

(270) 487-9664

NPI assigned

Jul 12, 2005

Last updated

Jan 10, 2017By 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 9

Medicare fee-for-service enrollment

Enrolled in KY

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

Specialty

Optometry

Education

Southern College of Optometry, 1969

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ross and Birge Inc.Group PAC ID 2365461415, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Monroe Medical Foundation Inc

  dba Monroe County Physician Associates

  • Rural Health Clinic/Center
  • Tompkinsville, KY
  • NPI 1629655816

  Corporate Director

  CMS ownership
• Monroe Medical Foundation Inc

  dba Monroe County Family Practice

  • Rural Health Clinic/Center
  • Tompkinsville, KY
  • NPI 1689255671

  Corporate Director

  CMS ownership
• Monroe Medical Foundation, Inc.

  dba Monroe County Medical Center

  • General Acute Care Hospital
  • Tompkinsville, KY
  • NPI 1053499350

  Corporate Director

  CMS ownership
• Monroe Medical Foundation, Inc.

  dba Monroe County Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Tompkinsville, KY
  • NPI 1295143360

  Corporate Director

  CMS ownership

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.

• Ross & Birge Inc

  • Optometrist
  • Tompkinsville, KY
  • NPI 1386776169
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484006400000",
    "number": "1205834587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 EXECUTIVE DR",
            "city": "TOMPKINSVILLE",
            "state": "KY",
            "postal_code": "421677478",
            "telephone_number": "270-487-5741",
            "fax_number": "270-487-9664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 EXECUTIVE DR",
            "city": "TOMPKINSVILLE",
            "state": "KY",
            "postal_code": "421677478",
            "telephone_number": "270-487-5741",
            "fax_number": "270-487-9664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "WILLIE",
        "middle_name": "F",
        "name_suffix": "Jr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-12",
        "last_updated": "2017-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "755DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICINE",
            "identifier": "410049288",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE P-10",
            "identifier": "8846",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE CORP",
            "identifier": "1386776169",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386776169",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "03322",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205834587",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77007557",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000199526",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS VISION",
            "identifier": "5940",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Rogan I, M.S. CCC-SLP
• Rook and Spade LLC
• Joshua Roper, PHARMD
• Ross & Birge Inc
• Heather Lou Ross, OD
• Teresa L Sheffield, APRN
• Kimberly Jo Smith
• Rhiannon Smith
• Chelsea Spears, LPCA
• Payton Stout

• Optometrist in Tompkinsville, KY
• Providers in Tompkinsville, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.