Active NPI
Bianca Surti
- Optometrist
- Vernon Hills, IL
National Provider Identifier
1275015349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046011250
- Practice address
- 503 Hawthorne Shopping Center
Vernon Hills, IL 60061 - Phone
- (847) 816-1188
- NPI assigned
- Sep 5, 2018
- Last updated
- Sep 5, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046011250 | IL | Primary |
Addresses
Primary practice location
503 Hawthorne Shopping Center
Vernon Hills, IL 60061
Mailing address
2331 Chadwick Way
Mundelein, IL 60060-5381
Phone (847) 942-7779
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
835 E 162ND St
South Holland, IL 60473-2465
Phone (708) 333-4444
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046011250 | IL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Eye Institute PC | Optometrist | Current | Accepting new patients |
| Advanced Eyecare South Holland OD and Associates PC | Optometrist | Current | Accepting new patients |
| Luxottica of America Inc. | Past | Accepting new patients | |
| Luxottica of America Inc | Past | Accepting new patients | |
| Jasper Gulotta | Optometrist | Past | Accepting new patients |
Locations
835 E 162nd St
South Holland, IL 60473
Phone (312) 333-4444
2720 169th St
Hammond, IN 46323
Phone (219) 845-2020
Organizations & group practices 5
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.
-
dba Advanced Eyecare of South Holland
- Optometrist
- South Holland, IL
- NPI 1942749791
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536105600000",
"number": "1275015349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2331 CHADWICK WAY",
"city": "MUNDELEIN",
"state": "IL",
"postal_code": "600605381",
"telephone_number": "847-942-7779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "503 HAWTHORNE SHOPPING CENTER",
"city": "VERNON HILLS",
"state": "IL",
"postal_code": "60061",
"telephone_number": "847-816-1188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURTI",
"first_name": "BIANCA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-05",
"last_updated": "2018-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046011250",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vernon Hills, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; 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.