Individual provider Active NPI

Richard W Kleinert, MD

  • Ophthalmology Physician
  • Worcester, MA
National Provider Identifier
1417949918
Registry record updated Oct 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
232530 Issued in MA
Practice address
100 Front St
12TH FL
Worcester, MA 01608-1425
Phone
(508) 368-5510
Fax
(508) 368-5530
NPI assigned
Aug 19, 2005
Last updated
Oct 31, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X MD022472E PA
Ophthalmology Physician 207W00000X 232530 MA Primary

Addresses

Primary practice location

100 Front St
12TH FL
Worcester, MA 01608-1425

Mailing address

135 Gold Star Blvd
Worcester, MA 01606-2738
Phone (508) 856-9599

Other identifiers 1

IdentifierTypeStateIssuer
000934840MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD022472EPAMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Reliant Medical Group, Inc PastSince Oct 15, 2007 Accepting new patients

Organizations & group practices 1

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": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320019200000",
    "number": "1417949918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 GOLD STAR BLVD",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016062738",
            "telephone_number": "508-856-9599",
            "fax_number": "508-854-4997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 FRONT ST",
            "address_2": "12TH FL",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016081425",
            "telephone_number": "508-368-5510",
            "fax_number": "508-368-5530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLEINERT",
        "first_name": "RICHARD",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2011-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "PA",
            "license": "MD022472E",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MA",
            "license": "232530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000934840",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.