Kevin Thomas Coolbaugh, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

0601002107 Issued in VA

Practice address

1960 Electric Rd
Roanoke, VA 24018-1621

Phone

(540) 772-7171

Fax

(540) 774-8299

NPI assigned

Jun 22, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

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

Specialty

Optometry

Education

University of Houston - College of Optometry, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Care and Surgery PCGroup PAC ID 3678666096, 8 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

83.69 of 100Reported as group

Quality

100

Improvement activities

40

Cost

45.64

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Eye Care & Surgery PC

  • Ophthalmology Physician
  • Roanoke, VA
  • NPI 1962400168
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265068800000",
    "number": "1306842695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1960 ELECTRIC RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240181621",
            "telephone_number": "540-772-7171",
            "fax_number": "540-774-8299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1960 ELECTRIC RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240181621",
            "telephone_number": "540-772-7171",
            "fax_number": "540-774-8299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOLBAUGH",
        "first_name": "KEVIN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2010-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0601002107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9232800",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Haley Rebecca Cook
• Jessica Ann Cook, LPC
• Jonathan Patrick Cook, BTL
• Kimberly Alain Cook, FNP-BC
• Suzy Weddle Cook, COTA/L
• Shari L Coolbaugh, OD
• Emily P. Coonradt, LPTA, ATC
• Jennifer Marie Cooper
• Ray Orem Cooper
• Coots Ward Cross Dentistry

• Optometrist in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2010; 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.

Verify at the official NPI Registry.