Individual provider Active NPI

Samantha Butcher, OD

  • Optometrist
  • Carlinville, IL
National Provider Identifier
1417635137
Registry record updated Jul 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046.011734 Issued in IL
Practice address
270 N Broad St
Carlinville, IL 62626-1371
Phone
(217) 854-7611
NPI assigned
Jul 11, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046.011734 IL Primary

Addresses

Primary practice location

270 N Broad St
Carlinville, IL 62626-1371

Mailing address

270 N Broad St
Carlinville, IL 62626-1371
Phone (217) 854-7611

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20231016001767 IL Practitioner - Optometry 9032564778 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eyecare of Carlinville PCGroup PAC ID 9537394911, 2 clinicians

Practice addresses (Care Compare)

270 N Broad St
Carlinville, IL 62626-1371
Phone (217) 854-7611

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery25

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046.011734ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eyecare of Carlinville PC Optometrist CurrentSince Sep 1, 2023 Accepting new patients
Carlinville Eye Care PC Optometrist PastSince Jul 16, 2023 Accepting new patients

Locations

270 N Broad St
Carlinville, IL 62626
Phone (217) 854-7611

Organizations & group practices 2

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": "1689033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1417635137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 N BROAD ST",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626261371",
            "telephone_number": "217-854-7611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 N BROAD ST",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626261371",
            "telephone_number": "217-854-7611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTCHER",
        "first_name": "SAMANTHA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-11",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.011734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carlinville, IL

Sources for this page

Verify at the official NPI Registry.