Individual provider Active NPI

Robert Stover, OD

  • Optometrist
  • Chattanooga, TN
National Provider Identifier
1447735147
Registry record updated Jul 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3800 Issued in TN
Practice address
568 Molly LN
Chattanooga, TN 37402-2254
Phone
(704) 718-1099
NPI assigned
Sep 27, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2311 SC
Optometrist 152W00000X OPT003129 GA
Optometrist 152W00000X 3800 TN Primary

Addresses

Primary practice location

568 Molly LN
Chattanooga, TN 37402-2254

Mailing address

568 Molly LN
Chattanooga, TN 37402-2254
Phone (704) 718-1099

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC, TN3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20190211001057 GA Practitioner - Optometry 0345588752 Reassigns benefits to 2 organizations
I20211126000002 SC Practitioner - Optometry 0345588752 Reassigns benefits to 1 organization
I20230725001848 TN Practitioner - Optometry 0345588752 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
360Care Services of Georgia LLCGroup PAC ID 5991145112, 7 clinicians

Practice addresses (Care Compare)

40 Technology Pkwy S
Norcross, GA 30092-2987
Phone (248) 528-2116

Merit-based Incentive Payment System (MIPS)

Final score
94.06 of 100Reported as group
Quality
79.74
Promoting interoperability
84
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
50.8 of 100Reported as individual
Quality
0
Promoting interoperability
86
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3800TNMDProfessional Counselor
2311SCMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
360Care Services of Georgia LLC Optometrist CurrentSince Mar 27, 2024 Accepting new patients
Mobile Vision of South Carolina, LLC Optometrist CurrentSince Nov 15, 2021 Accepting new patients
Jessup Mobile Opt TN LLC Optometrist CurrentSince Jun 10, 2023 Accepting new patients
Mobile Medical Eye Care LLC Optometrist CurrentSince Oct 29, 2021 Accepting new patients

Locations

12910 Shelbyville Rd
Ste 300
Louisville, KY 40243
Phone (502) 214-0693

4350 Brownsboro Rd
Ste 210
Louisville, KY 40207
Phone (830) 212-1661

12910 Shelbyville Rd
Ste 128
Louisville, KY 40243

1703 Laurel St
Columbia, SC 29201
Phone 24852821166

717 Trolley Rd
Summerville, SC 29485

Organizations & group practices 4

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": "1538006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1447735147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "568 MOLLY LN",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374022254",
            "telephone_number": "704-718-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "568 MOLLY LN",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374022254",
            "telephone_number": "704-718-1099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOVER",
        "first_name": "ROBERT",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-27",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "2311",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT003129",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "3800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

Verify at the official NPI Registry.