Active NPI
John E. Gaetani, OD
- Optometrist
- Old Town, ME
National Provider Identifier
1497759989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT759
- Practice address
- 614 Stillwater Ave
Old Town, ME 04468-2120 - Phone
- (207) 827-2616
- Fax
- (207) 827-3244
- NPI assigned
- Jun 13, 2005
- Last updated
- Mar 5, 2014
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT759 | ME | Primary |
Addresses
Primary practice location
614 Stillwater Ave
Old Town, ME 04468-2120
Mailing address
614 Stillwater Ave
Old Town, ME 04468-2120
Phone (207) 827-2616
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 254540099 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME
- 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
- New England College of Optometry, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
614 Stillwater Ave
Old Town, ME 04468-2120
Phone (207) 827-2616
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Optometrist
- Old Town, ME
- NPI 1356483846
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393977600000",
"number": "1497759989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "614 STILLWATER AVE",
"city": "OLD TOWN",
"state": "ME",
"postal_code": "044682120",
"telephone_number": "207-827-2616",
"fax_number": "207-827-3244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "614 STILLWATER AVE",
"city": "OLD TOWN",
"state": "ME",
"postal_code": "044682120",
"telephone_number": "207-827-2616",
"fax_number": "207-827-3244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAETANI",
"first_name": "JOHN",
"middle_name": "E.",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-13",
"last_updated": "2014-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "ME",
"license": "OPT759",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "254540099",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Old Town, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2014; 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.