Individual provider Active NPI

Kilah Shea Atkinson, O.D.

  • Optometrist
  • Redmond, OR
National Provider Identifier
1497057459
Registry record updated Dec 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3434ATI Issued in OR
Practice address
443 SW Evergreen Ave
Redmond, OR 97756-2817
Phone
(541) 923-2221
Fax
(541) 923-3776
NPI assigned
Nov 24, 2010
Last updated
Dec 6, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3434ATI OR Primary

Addresses

Primary practice location

443 SW Evergreen Ave
Redmond, OR 97756-2817

Mailing address

PO Box 918
Redmond, OR 97756-0206
Phone (541) 923-2221

Other identifiers 1

IdentifierTypeStateIssuer
500642657MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20120410000179 OR Practitioner - Optometry 0941483978 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ochoco Vision Source LLPGroup PAC ID 7113938440, 4 clinicians
High Desert EyecareGroup PAC ID 6901892801, 4 clinicians

Practice addresses (Care Compare)

340 NW Beaver St
Prineville, OR 97754-1836
Phone (541) 416-2020

443 SW Evergreen Ave
Redmond, OR 97756-2817
Phone (541) 923-2221

Merit-based Incentive Payment System (MIPS)

Final score
89.08 of 100Reported as group
Quality
78.16
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery19

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3434ATIORMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Ochoco Vision Source LLP Optometrist CurrentSince Jan 21, 2012 Accepting new patients
High Desert Eyecare Optometrist CurrentSince Feb 28, 2012 Accepting new patients
Therapeutic Associates Inc Past Accepting new patients
Aeg Texas Professional PLLC Optometrist Past Accepting new patients
Abdep LP Optometrist Past Accepting new patients
DRS. Bell, Davis, Elder & Assoc Optometrist Past Accepting new patients

Locations

340 NW Beaver St
Prineville, OR 97754
Phone (541) 416-2020

404 NW 5th St
Redmond, OR 97756
Phone (541) 923-2221

443 SW Evergreen Ave
Redmond, OR 97756
Phone (541) 923-2221

Organizations & group practices 6

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": "1290556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670284800000",
    "number": "1497057459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 918",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977560206",
            "telephone_number": "541-923-2221",
            "fax_number": "541-923-3776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "443 SW EVERGREEN AVE",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977562817",
            "telephone_number": "541-923-2221",
            "fax_number": "541-923-3776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATKINSON",
        "first_name": "KILAH",
        "middle_name": "SHEA",
        "name_prefix": "Mrs.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-24",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3434ATI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500642657",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Redmond, OR

Sources for this page

Verify at the official NPI Registry.