Brent Ryan Davidson, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

2005009915 Issued in MO

Practice address

1011 Bowles Ave
Suite 415
Fenton, MO 63026-2395

Phone

(636) 717-1700

Fax

(636) 203-4727

NPI assigned

Mar 9, 2006

Last updated

Jan 23, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 12

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

Saint Louis University School of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Envision Eye Specialists PCGroup PAC ID 0042375941, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Parkland Health Center Hospital, Farmington, MO, CCN 260163

Merit-based Incentive Payment System (MIPS)

Final score

91.88 of 100Reported as group

Quality

83.76

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Envision Eye Specialists PC

  • Ophthalmology Physician
  • Fenton, MO
  • NPI 1205072360
  Medicare reassignment Care Compare group NPD
• Faris Al-Gebory MD LLC

  • Surgery Physician
  • Fenton, MO
  • NPI 1891025615
  NPD (past)
• Missouri Eye Associates LLC

  • Ophthalmology Physician
  • Saint Louis, MO
  • NPI 1255478095
  NPD (past)
• Eye Specialist of Southern Illinois, LLC

  dba Kies Eye Center

  • Ophthalmology Physician
  • Marion, IL
  • NPI 1528020401
  NPD (past)

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

• Parkland Health Center

  dba Parkland Health Center - Farmington

  • General Acute Care Hospital
  • Farmington, MO
  • NPI 1003824061
  Care Compare affiliation
• Parkland Health Center

  dba Parkland Health Center - Farmington

  • Psychiatric Hospital Unit
  • Farmington, MO
  • NPI 1902814866
  Care Compare affiliation

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421971200000",
    "number": "1437127065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 BOWLES AVE",
            "address_2": "SUITE 200",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262395",
            "telephone_number": "636-717-1700",
            "fax_number": "636-203-4727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 BOWLES AVE",
            "address_2": "SUITE 415",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262395",
            "telephone_number": "636-717-1700",
            "fax_number": "636-203-4727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "BRENT",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2015-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MO",
            "license": "2005009915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "109208",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00238356",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH PLAN",
            "identifier": "226523",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "714579",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "10032015",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "5617586",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00339415",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "113109",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "199422",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "753168118",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "714579",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207319807",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• CVPT-Olivette, LLC (St. Louis Physical Therapy)
• Daisy Grace Home Health Care LLC
• Kimberly Michelle Daller, FNP-BC
• Vandana Dalton, M.D.
• Daniel F. Guerra DMD, LLC (Eat Right Dentures)
• Allison K Davis, M.D.
• Davis, Wright, Berdy & Suffian PC (Allergy Consultants)
• Dawn McFarland PSYD LLC
• Day Optometry, Inc. (Fenton Family Eyecare)
• Deco Dental

• Ophthalmology Physician in Fenton, MO
• Providers in Fenton, MO by specialty
• Ophthalmology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.