Individual provider Active NPI

Elizabeth Marie Monroe, O.D.

  • Optometrist
  • Hannibal, MO
National Provider Identifier
1356687412
Registry record updated Aug 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2012028150 Issued in MO
Practice address
175 Shinn LN
Hannibal, MO 63401-6754
Phone
(573) 248-0008
Fax
(573) 248-3097
NPI assigned
Dec 18, 2012
Last updated
Aug 29, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046010641 IL
Optometrist 152W00000X 2012028150 MO Primary

Addresses

Primary practice location

175 Shinn LN
Hannibal, MO 63401-6754

Mailing address

1025 Maine St
Quincy, IL 62301-4096
Phone (217) 222-6550

Other practice location 1

215 Progress Rd
Hannibal, MO 63401-6637
Phone (573) 248-1616

Other identifiers 2

IdentifierTypeStateIssuer
1356687412MedicaidIL
1356687412MedicaidMO

Other names 1

  • Elizabeth Marie Navitsky Former name

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20130328000404 MO Practitioner - Optometry 5496990145 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

175 Shinn LN
Hannibal, MO 63401-6754
Phone (573) 248-0008

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2012028150MOMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Quincy Physicians & Surgeons Clinic, PLLC CurrentSince Aug 5, 2022 Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC CurrentSince Aug 5, 2022 Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC Past Accepting new patients

Locations

1025 Maine St
Quincy, IL 62301
Phone 21722265503163

175 Shinn Ln
Hannibal, MO 63401
Phone (573) 248-0008

6000 Hospital Dr
Hannibal, MO 63401
Phone (573) 248-5460

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1355788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661731200000",
    "number": "1356687412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 MAINE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623014096",
            "telephone_number": "217-222-6550",
            "fax_number": "217-277-2253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 SHINN LN",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016754",
            "telephone_number": "573-248-0008",
            "fax_number": "573-248-3097"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "215 Progress Rd",
            "address_purpose": "LOCATION",
            "city": "Hannibal",
            "state": "MO",
            "postal_code": "634016637",
            "country_code": "US",
            "telephone_number": "573-248-1616",
            "fax_number": "573-248-1963",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONROE",
        "first_name": "ELIZABETH",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-18",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010641",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2012028150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356687412",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356687412",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "NAVITSKY",
            "middle_name": "MARIE",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Hannibal, MO

Sources for this page

Verify at the official NPI Registry.