Individual provider Active NPI

Reham Adel Baghdady, OD

  • Optometrist
  • Merrillville, IN
National Provider Identifier
1417404690
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901005012 Issued in MI
Practice address
279 W 80TH PL
Merrillville, IN 46410-5491
Phone
(219) 738-2180
NPI assigned
Sep 6, 2016
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18004011 IN
Optometrist 152W00000X 4901005012 MI Primary

Addresses

Primary practice location

279 W 80TH PL
Merrillville, IN 46410-5491

Mailing address

362 E 125TH PL
Crown Point, IN 46307-7546
Phone (219) 789-9429

Other practice location 1

6800 S Westnedge Ave
Portage, MI 49002-3596
Phone (412) 772-8252

Other identifiers 1

IdentifierTypeStateIssuer
18004011OtherINLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190827001289 NJ Practitioner - Optometry 5193088664
I20211103002892 NY Practitioner - Optometry 5193088664 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18004011INMDOptometrist
4901005012MIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Empire Vision Center, Inc CurrentSince Sep 1, 2021 Accepting new patients
Empire Vision Center Inc Optometrist CurrentSince Sep 1, 2021 Accepting new patients
Campus Eye Group, LLC Optometrist CurrentSince Jun 22, 2019 Accepting new patients
Campus Eye Group ASC, LLC Current Accepting new patients
Campus Eye Group, LLC Optometrist CurrentSince Jun 22, 2019 Accepting new patients

Locations

1700 Whitehorse Hamilton Square Rd
Ste A1
Trenton, NJ 08690
Phone (215) 781-2020

2680 Delaware Ave
Ste C
Buffalo, NY 14216
Phone (716) 873-1241

560 Troy Schenectady Rd
#7
Latham, NY 12110
Phone (518) 783-0090

1498 Deer Park Ave
North Babylon, NY 11703
Phone (631) 242-6730

1930 South Rd
#105
Poughkeepsie, NY 12601
Phone (845) 298-3200

2590 W Ridge Rd
Rochester, NY 14626
Phone (585) 227-7150

2921 Erie Blvd E
Syracuse, NY 13224
Phone (315) 446-3145

Organizations & group practices 5

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": "1473120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1417404690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "362 E 125TH PL",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463077546",
            "telephone_number": "219-789-9429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "279 W 80TH PL",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464105491",
            "telephone_number": "219-738-2180"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6800 S Westnedge Ave",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "MI",
            "postal_code": "490023596",
            "country_code": "US",
            "telephone_number": "412-772-8252",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAGHDADY",
        "first_name": "REHAM",
        "middle_name": "ADEL",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-06",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18004011",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901005012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "18004011",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Merrillville, IN

Sources for this page

Verify at the official NPI Registry.