Individual provider Active NPI

Cody Patterson, O.D.

  • Optometrist
  • Jonesboro, AR
National Provider Identifier
1417330101
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2723 Issued in AR
Practice address
623 E Matthews Ave Ste a
Jonesboro, AR 72401-3145
Phone
(870) 932-2211
Fax
(870) 972-5152
NPI assigned
Jun 30, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2723 AR Primary

Addresses

Primary practice location

623 E Matthews Ave Ste a
Jonesboro, AR 72401-3145

Mailing address

1815 E Highland Dr
Jonesboro, AR 72401-6118
Phone (870) 931-2020

Other practice location 1

HWY 67 South
Pocahontas, AR 72455
Phone (870) 932-2211

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20150930000887 AR Practitioner - Optometry 1052629789 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vision Care Center of Northeast Arkansas LLCGroup PAC ID 2860470374, 8 clinicians

Practice addresses (Care Compare)

623 E Matthews Ave
Jonesboro, AR 72401-3145

Merit-based Incentive Payment System (MIPS)

Final score
92.22 of 100Reported as group
Quality
98.17
Improvement activities
40
Cost
76.49

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2723ARMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Jonathan B. Ross OD PA Optometrist CurrentSince Aug 1, 2015 Accepting new patients
Vision Care Center of Northeast Arkansas LLC Optometrist CurrentSince Jun 1, 2023 Accepting new patients
Southern Eye Associates, LTD Optometrist Past Accepting new patients

Locations

623 E Matthews Ave
Jonesboro, AR 72401
Phone (870) 536-4100

623 E Matthews Ave
Ste A
Jonesboro, AR 72401
Phone (870) 932-2211

1815 E Highland Dr
Jonesboro, AR 72401
Phone (870) 931-2020

2401 Highway 67 S
Pocahontas, AR 72455
Phone (870) 892-4472

Interoperability endpoints

  • Direct secure messaging: cpatterson@vccna.intellechartdirect.net

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1435622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1417330101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 E HIGHLAND DR",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724016118",
            "telephone_number": "870-931-2020",
            "fax_number": "870-932-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 E MATTHEWS AVE STE A",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013145",
            "telephone_number": "870-932-2211",
            "fax_number": "870-972-5152"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "HWY 67 South",
            "address_purpose": "LOCATION",
            "city": "Pocahontas",
            "state": "AR",
            "postal_code": "72455",
            "country_code": "US",
            "telephone_number": "870-932-2211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATTERSON",
        "first_name": "CODY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-30",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

Verify at the official NPI Registry.