Individual provider Active NPI

Camille M. Harrison, MD

  • Ophthalmology Physician
  • Rancho Mirage, CA
National Provider Identifier
1366520140
Registry record updated Oct 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
A64900 Issued in CA
Practice address
72301 Country Club Dr
Suite 108
Rancho Mirage, CA 92270-8007
Phone
(760) 895-1993
Fax
(760) 862-1992
NPI assigned
Nov 1, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X A64900 CA Primary

Addresses

Primary practice location

72301 Country Club Dr
Suite 108
Rancho Mirage, CA 92270-8007

Mailing address

72301 Country Club Dr
Suite 108
Rancho Mirage, CA 92270-8007
Phone (760) 895-1993

Other identifiers 1

IdentifierTypeStateIssuer
00A649000MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100308000780 CA Practitioner - Ophthalmology 5991840431 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Baylor College of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

72301 Country Club Dr
Suite 108
Rancho Mirage, CA 92270-8007
Phone (760) 895-1993

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
64900CAMDGeneral Practice Dentistry
A64900CAMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Coachella Valley Retina Ophthalmology CurrentSince Oct 1, 2013 Accepting new patients
Lauren R Rosecan Mdpa PastSince Jul 31, 2001 Accepting new patients
Eisenhower Medical Center Past Accepting new patients
Coachella Valley Retina Ophthalmology Past Accepting new patients
Diagnostic Imaging Services Past Accepting new patients

Locations

72301 Country Club Dr
Ste 108
Rancho Mirage, CA 92270
Phone (760) 346-0553

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381795200000",
    "number": "1366520140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72301 COUNTRY CLUB DR",
            "address_2": "SUITE 108",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922708007",
            "telephone_number": "760-895-1993",
            "fax_number": "760-862-1992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72301 COUNTRY CLUB DR",
            "address_2": "SUITE 108",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922708007",
            "telephone_number": "760-895-1993",
            "fax_number": "760-862-1992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "CAMILLE",
        "middle_name": "M.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2013-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "A64900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A649000",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Mirage, CA

Sources for this page

Verify at the official NPI Registry.