Individual provider Active NPI

Timothy Richard Klugh, O.D.

  • Optometrist
  • Washington, NC
National Provider Identifier
1407819212
Registry record updated Mar 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1603 Issued in NC
Practice address
1730 Carolina Ave
Washington, NC 27889-3315
Phone
(252) 946-2171
Fax
(252) 946-5986
NPI assigned
Apr 11, 2006
Last updated
Mar 7, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1603 NC Primary

Addresses

Primary practice location

1730 Carolina Ave
Washington, NC 27889-3315

Mailing address

1730 Carolina Ave
Washington, NC 27889-3315
Phone (252) 946-2171

Other identifiers 2

IdentifierTypeStateIssuer
0194WOtherNCBCBSN C
890903EMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20110413000502 NC Practitioner - Optometry 9739363946 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Albemarle Eye Center PLLCGroup PAC ID 4981696499, 7 clinicians

Practice addresses (Care Compare)

1730 Carolina Ave
Washington, NC 27889-3315
Phone (252) 946-2171

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

Practice roles

OrganizationSpecialtyStatusNew patients
Albemarle Eye Center, PLLC CurrentSince Jul 21, 2015 Accepting new patients
Albemarle Eye Center, PLLC Optometrist CurrentSince Jul 21, 2015 Accepting new patients
Albemarle Eye Center, PLLC Optometrist Past Accepting new patients

Locations

1503 N Road St
Elizabeth Cty, NC 27909
Phone 25233554462237

1730 Carolina Ave
Washington, NC 27889
Phone (252) 946-2171

Organizations & group practices 3

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": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457308800000",
    "number": "1407819212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 CAROLINA AVE",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278893315",
            "telephone_number": "252-946-2171",
            "fax_number": "252-946-5986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 CAROLINA AVE",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278893315",
            "telephone_number": "252-946-2171",
            "fax_number": "252-946-5986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLUGH",
        "first_name": "TIMOTHY",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-11",
        "last_updated": "2016-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSN C",
            "identifier": "0194W",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890903E",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, NC

Sources for this page

Verify at the official NPI Registry.