Individual provider Active NPI

Pierce E Kenworthy, OD

  • Optometrist
  • Glendale, AZ
National Provider Identifier
1447668553
Registry record updated Dec 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT-002162 Issued in AZ
Practice address
5865 W Utopia Rd
Glendale, AZ 85308-5251
Phone
(623) 806-7200
Fax
(623) 806-7210
NPI assigned
Aug 1, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 8515T TX
Optometrist 152W00000X OPT-002162 AZ Primary

Addresses

Primary practice location

5865 W Utopia Rd
Glendale, AZ 85308-5251

Mailing address

19389 N 59TH Ave
Glendale, AZ 85308-6500
Phone (623) 537-6000

Other identifiers 2

IdentifierTypeStateIssuer
1124091-04MedicaidTX
255238MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20170310000405 AZ Practitioner - Optometry 3274755467 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwestern UniversityGroup PAC ID 6305734773, 116 clinicians

Practice addresses (Care Compare)

5865 W Utopia Rd
Glendale, AZ 85308-5251
Phone (623) 537-6000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT-002162AZMDOptometrist
8515TTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Midwestern University Optometrist CurrentSince Feb 4, 2017 Accepting new patients
Midwestern University Optometrist Current Accepting new patients
Midwestern University Optometrist CurrentSince Feb 4, 2017 Accepting new patients

Locations

19389 N 59th Ave
Glendale, AZ 85308

5865 W Utopia Rd
Glendale, AZ 85308
Phone (623) 806-7200

26520 Network Pl
Chicago, IL 60673
Phone (630) 743-4500

Interoperability endpoints

  • Direct secure messaging: pierce.kenworthy.p3@direct.midwesternuniversity.nextgenshare.com
  • Direct secure messaging: pkenworthy18545@direct.midwestern.edu

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": "1406851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576022400000",
    "number": "1447668553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19389 N 59TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086500",
            "telephone_number": "623-537-6000",
            "fax_number": "623-537-6014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5865 W UTOPIA RD",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853085251",
            "telephone_number": "623-806-7200",
            "fax_number": "623-806-7210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENWORTHY",
        "first_name": "PIERCE",
        "middle_name": "E",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-01",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "8515T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "OPT-002162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124091-04",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "255238",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.