NPIMap

Organization Active NPI

Retina Associates, PSC

  • Ophthalmology Physician
  • Louisville, KY
National Provider Identifier
1285639666
Registry record updated Oct 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
31573 Issued in KY
Legal business name
RETINA ASSOCIATES, PSC
Practice address
1536 Story Ave
The Eye Care Institute Building
Louisville, KY 40206-1738
Phone
(502) 589-1500
Fax
(502) 589-1556
NPI assigned
Jun 14, 2005
Last updated
Oct 15, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2018

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

Authorized official

Name
Mr. Mark M Prussian, MBA, FACHE, COE
Title
Administrator
Phone
(502) 589-1500

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 1136DT KY
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 1614DT KY
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 1613DT KY
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X 31573 KY Primary
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X 28804 KY
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X 28590 KY
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X 01043769 IN
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X 01043733 IN
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X 01040010 IN

Addresses

Primary practice location

1536 Story Ave
The Eye Care Institute Building
Louisville, KY 40206-1738

Mailing address

1536 Story Ave
The Eye Care Institute Building
Louisville, KY 40206-1738
Phone (502) 589-1500

Other identifiers 5

IdentifierTypeStateIssuer
779033591OtherKYGROUP OD MEDICAID NUMBER
100221560AMedicaidIN
1121048OtherKYGROUP PASSPORT NUMBER
65917502MedicaidKY
CF7698OtherKYGROUP RR MEDICARE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031218000552 KY Part B Supplier - Clinic/Group Practice 5991602757 Receives reassigned benefits from 10 practitioners
Practice locations: Louisville, KY
O20061012000212 IN Part B Supplier - Clinic/Group Practice 5991602757 Receives reassigned benefits from 4 practitioners
Practice locations: Jeffersonville, IN
O20100930017282 KY DME Supplier - Physician - Optometrist 5991602757 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Louisville, KY

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

441 Green Rd
Madison, IN 47250
Phone (812) 273-2020

1945 Scottsville Rd
Ste 201B
Bowling Green, KY 42104
Phone (800) 999-3036

1536 Story Ave
Louisville, KY 40206
Phone (502) 589-1500

Interoperability endpoints

  • Direct secure messaging: bgreene@eyecareinstitute.intellechartdirect.net
  • Direct secure messaging: gpattar@eyecareinstitute.intellechartdirect.net
  • Direct secure messaging: hwoodruff@eyecareinstitute.intellechartdirect.net
  • Direct secure messaging: jmeyer@eyecareinstitute.intellechartdirect.net
  • Direct secure messaging: jyunker@eyecareinstitute.intellechartdirect.net
  • Direct secure messaging: tharper@eyecareinstitute.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539561600000",
    "number": "1285639666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1536 STORY AVE",
            "address_2": "THE EYE CARE INSTITUTE BUILDING",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402061738",
            "telephone_number": "502-589-1500",
            "fax_number": "502-589-1556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1536 STORY AVE",
            "address_2": "THE EYE CARE INSTITUTE BUILDING",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402061738",
            "telephone_number": "502-589-1500",
            "fax_number": "502-589-1556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA ASSOCIATES, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-14",
        "last_updated": "2018-10-15",
        "status": "A",
        "authorized_official_last_name": "PRUSSIAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "502-589-1500",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA, FACHE, COE"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1136DT",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1614DT",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1613DT",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "KY",
            "license": "31573",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "KY",
            "license": "28804",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "KY",
            "license": "28590",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "IN",
            "license": "01043769",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "IN",
            "license": "01043733",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "IN",
            "license": "01040010",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP OD MEDICAID NUMBER",
            "identifier": "779033591",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100221560A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PASSPORT NUMBER",
            "identifier": "1121048",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65917502",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP RR MEDICARE NUMBER",
            "identifier": "CF7698",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2018; 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.