Active NPI
Derrick Badaracco
- Optometrist
- Buford, GA
National Provider Identifier
1457767253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- GA 2860
- Practice address
- 3290 Buford Dr
Suite B-2
Buford, GA 30519-4928 - Phone
- (724) 799-1387
- NPI assigned
- Jul 1, 2014
- Last updated
- Oct 16, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 0618002352 | VA | |
| Optometrist | 152W00000X | GA 2860 | GA | Primary |
Addresses
Primary practice location
3290 Buford Dr
Suite B-2
Buford, GA 30519-4928
Mailing address
4180 Butler Dr
Chamblee, GA 30341-1361
Phone (724) 799-1387
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- State University of New York - State College Optometry, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
3290 Buford Dr
Suite B2
Buford, GA 30519-5701
Phone (770) 932-1670
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| GA 2860 | GA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eyedoc Investments LLC | Optometrist | Current | Accepting new patients |
| Mark Lynn OD & Associates, PC | Optometrist | Current | Accepting new patients |
| Mark Lynn O.D. & Associates, PC | Current | Accepting new patients | |
| Nevus Eye LLC | Optometrist | Current | Accepting new patients |
| Star Optometry Ga LLC | Optometrist | Past | Accepting new patients |
Locations
2855 Jordan Ct
Alpharetta, GA 30004
Phone (678) 823-4954
3290 Buford Dr
Ste B2
Buford, GA 30519
Phone (724) 799-1387
2929 Turner Hill Rd
Ste 2625
Lithonia, GA 30038
Phone (770) 482-5050
Organizations & group practices 5
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404172800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729036800000",
"number": "1457767253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4180 BUTLER DR",
"city": "CHAMBLEE",
"state": "GA",
"postal_code": "303411361",
"telephone_number": "724-799-1387"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3290 BUFORD DR",
"address_2": "SUITE B-2",
"city": "BUFORD",
"state": "GA",
"postal_code": "305194928",
"telephone_number": "724-799-1387"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BADARACCO",
"first_name": "DERRICK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-01",
"last_updated": "2024-10-16",
"certification_date": "2024-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "VA",
"license": "0618002352",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "GA",
"license": "GA 2860",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buford, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; 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.