Individual provider Active NPI

Donald J Gossom, O.D.

  • Corneal and Contact Management Optometrist
  • Louisville, KY
National Provider Identifier
1457325896
Registry record updated Jan 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Corneal and Contact Management OptometristTaxonomy code 152WC0802X
License
1364DT Issued in KY
Practice address
7635 Shelbyville Rd
Louisville, KY 40222-5409
Phone
(502) 423-8500
Fax
(502) 339-0571
NPI assigned
Feb 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management Optometrist 152WC0802X 1364DT KY Primary

Addresses

Primary practice location

7635 Shelbyville Rd
Louisville, KY 40222-5409

Mailing address

7635 Shelbyville Rd
Louisville, KY 40222-5409
Phone (502) 423-8500

Other identifiers 3

IdentifierTypeStateIssuer
77013647MedicaidKY
000000047535OtherKYANTHEM BCBS
5420222OtherAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20100617000696 KY Practitioner - Optometry 3072643030 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gaddie Eye Centers LLCGroup PAC ID 6103898895, 8 clinicians

Practice addresses (Care Compare)

7635 Shelbyville Rd
Louisville, KY 40222-5409
Phone (502) 423-8500

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery27

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Gaddie Eye Centers, LLC Corneal and Contact Management CurrentSince Apr 28, 2010 Accepting new patients

Locations

2555 Highway 227
Carrollton, KY 41008
Phone (502) 662-0107

2028 S Highway 53
Ste 7
Lagrange, KY 40031
Phone (502) 225-0301

1917 S Highway 53
Lagrange, KY 40031
Phone (502) 225-0301

9850 Von Allmen Ct
Ste 105
Louisville, KY 40241
Phone (502) 429-3630

7635 Shelbyville Rd
Louisville, KY 40222
Phone (502) 371-4904

9474 Brownsboro Rd
Louisville, KY 40241
Phone (502) 429-8741

Interoperability endpoints

  • Direct secure messaging: donald.gossom@direct.revolutionehr.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548028800000",
    "number": "1457325896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7635 SHELBYVILLE RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402225409",
            "telephone_number": "502-423-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7635 SHELBYVILLE RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402225409",
            "telephone_number": "502-423-8500",
            "fax_number": "502-339-0571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOSSOM",
        "first_name": "DONALD",
        "middle_name": "J",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2019-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "KY",
            "license": "1364DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77013647",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000047535",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5420222",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.