Michael John Rotheker, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

18003124A Issued in IN

Practice address

17615 State Road 23
South Bend, IN 46635

Phone

(574) 234-7600

Fax

(574) 234-8408

NPI assigned

Oct 13, 2005

Last updated

Aug 14, 2018By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Enrolled in IN

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

Illinois College of Optometry at Chicago, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Boling Vision Center LLCGroup PAC ID 6103921556, 12 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

92.44 of 100Reported as group

Quality

100

Improvement activities

40

Cost

74.81

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mrotheker@directaddress.net

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.

• Boling Vision Center, LLC

  • Ophthalmology Physician
  • Elkhart, IN
  • NPI 1003851445
  Medicare reassignment Care Compare group NPD
• Midwest Eye Consultants, P.C.

  dba Cataract & Laser Institute

  • Ophthalmology Physician
  • Fort Wayne, IN
  • NPI 1912960535
  Medicare reassignment NPD
• Longe Optical

  • Durable Medical Equipment & Medical Supplies
  • Merrillville, IN
  • NPI 1013168038
  NPD (past) Authorized official
• Boling Vision Center, LLC

  • Eyewear Supplier
  • Goshen, IN
  • NPI 1467585885
  NPD
• Christopher J. Wolf, OD, Inc

  • Optometrist
  • South Bend, IN
  • NPI 1023069283
  NPD (past)
• Eyecare Indiana LL, PC

  dba C&B Optical One

  • Optometrist
  • Mishawaka, IN
  • NPI 1134485360
  NPD (past)
• Northern Indiana Optometrists, PC

  • Optometrist
  • South Bend, IN
  • NPI 1841215738
  NPD (past)

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534204800000",
    "number": "1316935208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4121 S. MICHIGAN STREET",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466142545",
            "telephone_number": "574-291-9200",
            "fax_number": "574-299-4423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17615 STATE ROAD 23",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "46635",
            "telephone_number": "574-234-7600",
            "fax_number": "574-234-8408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTHEKER",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-13",
        "last_updated": "2018-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003124A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM MC/BS",
            "identifier": "000000215766",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200335390A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trinity Ross, RBT
• Betsy Rossow, MD
• Janya Lajoyce Roston
• Colin M Roth
• Ted M. Roth, MD
• Michael C Rotkis, MD
• April Rowe, MSW, LCSW
• Kara K. Rowe, R.D.
• Arnulfo Ayalde Royeca, PT
• Regina Rozenblit

• Optometrist in South Bend, IN
• Providers in South Bend, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 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.

Verify at the official NPI Registry.