Individual provider Active NPI

Tiffenie A Harris, O.D.

  • Optometrist
  • Pomona, CA
National Provider Identifier
1497715031
Registry record updated Oct 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT13669TPA Issued in CA
Practice address
795 E 2ND St
Suite 2
Pomona, CA 91766-2007
Phone
(909) 706-3899
Fax
(909) 469-8640
NPI assigned
Mar 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT13669TPA CA Primary

Addresses

Primary practice location

795 E 2ND St
Suite 2
Pomona, CA 91766-2007

Mailing address

795 E 2ND St
Suite 2
Pomona, CA 91766-2007
Phone (909) 469-8773

Other identifiers 1

IdentifierTypeStateIssuer
CB240596OtherCAMEDICARE PTAN SO CAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20101129000050 CA Practitioner - Optometry 2163494717 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
86.49 of 100Reported as group
Quality
68.78
Improvement activities
40
Cost
78.85

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT13669TPACAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Western University of Health Sciences Optometrist CurrentSince Jul 16, 2015 Accepting new patients
Western University of Health Sciences CurrentSince Jul 16, 2015 Accepting new patients
Western University of Health Sciences Current Accepting new patients
Indiana University Optometrist Past Accepting new patients
Indiana University Past Accepting new patients

Locations

795 E 2nd St
Ste 5
Pomona, CA 91766
Phone (909) 706-3877

795 E 2nd St
Ste 2
Pomona, CA 91766
Phone (909) 469-8673

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: tharris195839@direct.ochin.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477872000000",
    "number": "1497715031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "795 E 2ND ST",
            "address_2": "SUITE 2",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917662007",
            "telephone_number": "909-469-8773",
            "fax_number": "909-469-5228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "795 E 2ND ST",
            "address_2": "SUITE 2",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917662007",
            "telephone_number": "909-706-3899",
            "fax_number": "909-469-8640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "TIFFENIE",
        "middle_name": "A",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-27",
        "last_updated": "2016-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT13669TPA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN SO CAL",
            "identifier": "CB240596",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.