NPIMap

Organization Active NPI

Great Hills Eye Care, PC

  • Optometrist
  • Georgetown, TX
National Provider Identifier
1497430953
Registry record updated Jun 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
GREAT HILLS EYE CARE, PC
Practice address
2201 N I-35
Ste a
Georgetown, TX 78628
Phone
(512) 793-7931
Fax
(512) 790-0991
NPI assigned
Jun 21, 2023
Organization subpart
Yes
Parent organization
GREAT HILLS EYE CARE, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

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

Authorized official

Name
Dr. Drew Provost, OD
Title
President
Phone
(512) 934-4444

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

2201 N I-35
Ste a
Georgetown, TX 78628

Mailing address

10401 Research Blvd Ste a
Austin, TX 78759-5712
Phone (512) 345-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130325000164 TX Part B Supplier - Clinic/Group Practice 4981849841 Receives reassigned benefits from 13 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Austin, TX; Georgetown, TX; Pflugerville, TX

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Great Hills Eye Care PC4 organizations share this tax ID, including this one
Part of
Great Hills Eye Care PC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10401 Research Blvd
#A
Austin, TX 78759
Phone (512) 345-2000

2201 N Interstate 35
Ste A
Georgetown, TX 78628
Phone (512) 793-7931

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1687305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687305600000",
    "number": "1497430953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10401 RESEARCH BLVD STE A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787595712",
            "telephone_number": "512-345-2000",
            "fax_number": "512-345-2002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 N I-35",
            "address_2": "STE A",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "78628",
            "telephone_number": "512-793-7931",
            "fax_number": "512-790-0991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT HILLS EYE CARE, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREAT HILLS EYE CARE, PC",
        "enumeration_date": "2023-06-21",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-09",
        "status": "A",
        "authorized_official_last_name": "PROVOST",
        "authorized_official_first_name": "DREW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-934-4444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.