NPIMap

Organization Active NPI

Jonathan B. Ross OD PA

  • Optometrist
  • Jonesboro, AR
National Provider Identifier
1225196132
Registry record updated May 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2493 Issued in AR
Legal business name
JONATHAN B. ROSS OD PA
Doing business as
ross vision care center
Practice address
1815 E Highland Dr
Jonesboro, AR 72401-6118
Phone
(870) 931-2020
Fax
(870) 932-8004
NPI assigned
Dec 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2009

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

Authorized official

Name
Dr. Jonathan Blake Ross, O.D.NPI 1881638328
Title
Owner
Phone
(870) 931-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2493 AR Primary

Addresses

Primary practice location

1815 E Highland Dr
Jonesboro, AR 72401-6118

Mailing address

1815 E Highland Dr
Jonesboro, AR 72401-6118
Phone (870) 931-2020

Other identifiers 2

IdentifierTypeStateIssuer
142832722MedicaidAR
5F545OtherARAR BLUE CROSS BLUE SHIELD

Other names 1

  • ross vision care center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090228000025 AR Part B Supplier - Clinic/Group Practice 0840356721 Receives reassigned benefits from 6 practitioners
Practice locations: Jonesboro, AR; Paragould, AR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242000000000",
    "number": "1225196132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 E HIGHLAND DR",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724016118",
            "telephone_number": "870-931-2020",
            "fax_number": "870-932-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 E HIGHLAND DR",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724016118",
            "telephone_number": "870-931-2020",
            "fax_number": "870-932-8004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JONATHAN B. ROSS OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2009-05-11",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "BLAKE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-931-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2493",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142832722",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR BLUE CROSS BLUE SHIELD",
            "identifier": "5F545",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ross vision care center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.