Kara Detsch

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG004159 Issued in PA

Practice address

20 N Broad St
Ridgway, PA 15853-8018

Phone

(814) 772-0674

NPI assigned

Feb 19, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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

Southern College of Optometry, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mary Reed Dacanal, OD Inc.Group PAC ID 4880669290, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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 and National Provider Directory roles.

• Mary Reed Dacanal, OD Inc.

  • Optometrist
  • Johnsonburg, PA
  • NPI 1013117019
  Medicare reassignment Care Compare group NPD
• Mary Reed Dacanal OD Inc.

  • Optometrist
  • Ridgway, PA
  • NPI 1699060335
  NPD (past)

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

{
    "created_epoch": "1708300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1396500328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 ADAMS RD",
            "city": "SAINT MARYS",
            "state": "PA",
            "postal_code": "158573613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 N BROAD ST",
            "city": "RIDGWAY",
            "state": "PA",
            "postal_code": "158538018",
            "telephone_number": "814-772-0674"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "516 Market St",
            "address_purpose": "LOCATION",
            "city": "Johnsonburg",
            "state": "PA",
            "postal_code": "158451240",
            "country_code": "US",
            "telephone_number": "814-965-3231",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DETSCH",
        "first_name": "KARA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-19",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG004159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Devin Davis
• Elizabeth Susan Delullo, LPC
• Erica Nicole Delullo
• Jacki Renee Depanfilis, PA-C
• Michael Francis Depanfilis, R.PH.
• Dickinson Center, Inc
• Dickinson Center, Inc
• Dickinson Center, Inc/Autism OT
• Dickinson Mental Health Center, Inc
• Andrew John Dornisch, P.T.

• Optometrist in Ridgway, PA
• Providers in Ridgway, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.