Michael Connell, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3638ATI Issued in OR

Practice address

1260 Lloyd Ctr
Portland, OR 97232-1301

Phone

(503) 331-3984

NPI assigned

Aug 13, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Optometry

Education

Southern College of Optometry, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Connell and Kim, O.D. Associates Limited Liability CompanyGroup PAC ID 3577983006, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Connell and Kim, O.D. Associates Limited Liability Company

  • Optometrist
  • Dawsonville, GA
  • NPI 1881212710
  Medicare reassignment Care Compare group NPD Authorized official
• Steven D. Elliott, O.D. & Associates, Inc.

  • Optometrist
  • Clinton, TN
  • NPI 1609231752
  NPD (past)
• Suzanne Kimmons, OD, PC

  • Eyewear Supplier
  • Dawsonville, GA
  • NPI 1013196377
  NPD (past)

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

{
    "created_epoch": "1407888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444348800000",
    "number": "1447669635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2944 NW MODA WAY",
            "address_2": "APT. 723",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971247023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 LLOYD CTR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321301",
            "telephone_number": "503-331-3984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNELL",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-08-13",
        "last_updated": "2015-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "3194",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3638ATI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Connected Healthcare, Inc.
• Connection Physical Therapy
• Connections First, LLC
• Connective Therapy Collective
• Ashleigh B Connell, MA, CCC-SLP
• R. Celeste Connell
• Angela Corvera Connelly, B.S. P.T.
• Christopher Robert Connelly, M.D.
• Greta Anne Connelly
• Jade Michelle Deck Connelly

• Optometrist in Portland, OR
• Providers in Portland, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 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.