NPIMap

Individual provider Active NPI

Laura Cottam Dewitt, O.D.

  • Optometrist
  • Teec Nos Pos, AZ
National Provider Identifier
1407936578
Registry record updated Sep 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG000350 Issued in PA
Practice address
US Hwy 190 and Navajo Route 35/Red Mesa
Teec Nos Pos, AZ 86514
Phone
(928) 656-5020
NPI assigned
Oct 16, 2006
Last updated
Sep 7, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 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 OEG000350 PA Primary

Addresses

Primary practice location

US Hwy 190 and Navajo Route 35/Red Mesa
Teec Nos Pos, AZ 86514

Mailing address

PO Box 160
Shiprock, NM 87420-0160
Phone (505) 368-6001

Other names 1

  • Dr. Laura Cottam Van Der Waag Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110914000537 TX Practitioner - Optometry 8022172501 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
DHHS PHS Naihs Shiprock HospitalGroup PAC ID 0749193837, 148 clinicians

Practice addresses (Care Compare)

US Hwy 160 and Navajo Route 35-Red Mesa
Teecnospos, AZ 86514
Phone (928) 656-5165

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.26 of 100Reported as group
Quality
74.27
Improvement activities
40
Cost
78.06

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS, PHS, Naihs, Shiprock Hospital Current Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Nov 1, 2014 Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Nov 1, 2014 Accepting new patients

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473206400000",
    "number": "1407936578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160",
            "city": "SHIPROCK",
            "state": "NM",
            "postal_code": "874200160",
            "telephone_number": "505-368-6001",
            "fax_number": "928-656-5021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "US HWY 190 AND NAVAJO ROUTE 35/RED MESA",
            "city": "TEEC NOS POS",
            "state": "AZ",
            "postal_code": "86514",
            "telephone_number": "928-656-5020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWITT",
        "first_name": "LAURA",
        "middle_name": "COTTAM",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2016-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "VAN DER WAAG",
            "middle_name": "COTTAM",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Teec Nos Pos, AZ

Sources for this page

Verify at the official NPI Registry.