Active NPI
Nicholas Michael McCullen, O.D.
- Optometrist
- Centerville, IA
National Provider Identifier
1376854745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 002489
- Practice address
- 125 N 13TH St
Centerville, IA 52544-1705 - Phone
- (641) 437-4099
- Fax
- (641) 437-0512
- NPI assigned
- Jun 30, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 002489 | IA | Primary |
Addresses
Primary practice location
125 N 13TH St
Centerville, IA 52544-1705
Mailing address
125 N 13TH St
Centerville, IA 52544-1705
Phone (641) 437-4099
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Southern College of Optometry, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2405 Ingersoll Ave
Des Moines, IA 50312-5233
Phone (515) 244-7740
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 21 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Real Optics Inc | Current | Accepting new patients |
Locations
2405 Ingersoll Ave
Des Moines, IA 50312
Phone (515) 244-2338
1141 N Quincy Ave
Ottumwa, IA 52501
Organizations & group practices 1
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.
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- Des Moines, IA
- NPI 1003970344
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1382400000000",
"number": "1376854745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 N 13TH ST",
"city": "CENTERVILLE",
"state": "IA",
"postal_code": "525441705",
"telephone_number": "641-437-4099",
"fax_number": "641-437-0512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 N 13TH ST",
"city": "CENTERVILLE",
"state": "IA",
"postal_code": "525441705",
"telephone_number": "641-437-4099",
"fax_number": "641-437-0512"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCULLEN",
"first_name": "NICHOLAS",
"middle_name": "MICHAEL",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-06-30",
"last_updated": "2013-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IA",
"license": "002489",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Centerville, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2013; 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.