NPIMap

Organization Active NPI

Specialty Pediatric Eye Care, LLC

  • Ophthalmology Physician
  • Beverly, MA
National Provider Identifier
1295120574
Registry record updated Jun 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
229695 Issued in MA
Legal business name
SPECIALTY PEDIATRIC EYE CARE, LLC
Practice address
77 Herrick St
Unit 102
Beverly, MA 01915-2734
Phone
(978) 338-4321
NPI assigned
Apr 2, 2015
Last updated
Jun 18, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
SPECIALIZED PEDIATRIC EYE CARE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 18, 2015

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

Authorized official

Name
Dr. Danielle Monique Ledoux, MDNPI 1528085982
Title
Physician/President
Phone
(978) 338-4321

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
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X 229695 MA Primary

Addresses

Primary practice location

77 Herrick St
Unit 102
Beverly, MA 01915-2734

Mailing address

77 Herrick St
Unit 102
Beverly, MA 01915-2734
Phone (978) 338-4321

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160609000017 MA Part B Supplier - Clinic/Group Practice 5294025995 Receives reassigned benefits from 1 practitioner
Practice locations: Beverly, MA

National Provider Directory

National Provider Directory
Part of
Specialized Pediatric Eye Care Inc

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

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": "1427932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434585600000",
    "number": "1295120574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 HERRICK ST",
            "address_2": "UNIT 102",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019152734",
            "telephone_number": "978-338-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 HERRICK ST",
            "address_2": "UNIT 102",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019152734",
            "telephone_number": "978-338-4321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALTY PEDIATRIC EYE CARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPECIALIZED PEDIATRIC EYE CARE, INC",
        "enumeration_date": "2015-04-02",
        "last_updated": "2015-06-18",
        "status": "A",
        "authorized_official_last_name": "LEDOUX",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_middle_name": "MONIQUE",
        "authorized_official_title_or_position": "PHYSICIAN/PRESIDENT",
        "authorized_official_telephone_number": "978-338-4321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "MA",
            "license": "229695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2015; 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.