Individual provider Active NPI

Sampson O Nosike, O.D.

  • Optometrist
  • Boston, MA
National Provider Identifier
1225093628
Registry record updated Aug 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4131 Issued in MA
Practice address
750 Washington St
# 450
Boston, MA 02111-1526
Phone
(617) 636-4600
Fax
(617) 636-4866
NPI assigned
Apr 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4131 MA Primary

Addresses

Primary practice location

750 Washington St
# 450
Boston, MA 02111-1526

Mailing address

339 School St
Watertown, MA 02472-1413
Phone (617) 625-3043

Other identifiers 1

IdentifierTypeStateIssuer
0313688MedicaidMA

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
I20060313000706 MA Practitioner - Optometry 2769499953 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pratt Ophthalmology Associates IncGroup PAC ID 8628960218, 55 clinicians

Practice addresses (Care Compare)

725 Concord Ave
Suite 2200
Cambridge, MA 02138-1040
Phone (617) 876-3660

800 Washington St
Boston, MA 02111-1552
Phone (617) 636-5487

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4131MAMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Tufts Medical Center, Inc. CurrentSince Sep 7, 1999 Accepting new patients
Pratt Ophthalmology Associates Inc CurrentSince Sep 7, 1999 Accepting new patients
Tufts Medical Center, Inc. CurrentSince Sep 7, 1999 Accepting new patients
Pratt Ophthalmology Associates, Inc CurrentSince Sep 7, 1999 Accepting new patients

Locations

750 Washington St
#450
Boston, MA 02111
Phone (617) 636-4600

800 Washington St
Boston, MA 02111
Phone (617) 636-4800

750 Washington St
Boston, MA 02111
Phone (617) 636-4600

750 Washington St
#833
Boston, MA 02111
Phone (617) 636-4800

Interoperability endpoints

  • Direct secure messaging: snosike181476@direct.ochin.org

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282262400000",
    "number": "1225093628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 SCHOOL ST",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024721413",
            "telephone_number": "617-625-3043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 WASHINGTON ST",
            "address_2": "# 450",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021111526",
            "telephone_number": "617-636-4600",
            "fax_number": "617-636-4866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOSIKE",
        "first_name": "SAMPSON",
        "middle_name": "O",
        "name_prefix": "Mr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2010-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0313688",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.