Individual provider Active NPI

Creighton Alan Simmons, O.D.

  • Optometrist
  • Benton, AR
National Provider Identifier
1508894304
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2383 Issued in AR
Practice address
113 W Carpenter St
Benton, AR 72015-3317
Phone
(501) 778-2363
Fax
(501) 778-5329
NPI assigned
Jun 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2383 AR Primary

Addresses

Primary practice location

113 W Carpenter St
Benton, AR 72015-3317

Mailing address

PO Box 2500
Benton, AR 72018-2500
Phone (501) 778-2363

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20100910000326 AR Practitioner - Optometry 5991820243 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SS Eye Group, PLLCGroup PAC ID 4486927035, 4 clinicians
C and R Eye Group PAGroup PAC ID 0042471914, 2 clinicians

Practice addresses (Care Compare)

11115 Hermitage Rd
Little Rock, AR 72211-3807
Phone (501) 224-7056

4328 Central Ave
Suite G
Hot Springs, AR 71913-7204
Phone (501) 525-1348

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery45

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
SS Eye Group, PLLC Optometrist CurrentSince Sep 27, 2017 Accepting new patients
Simmons Eye Care Clinic, P.a. Optometrist PastSince Jul 1, 1999 Accepting new patients
Randall L Teague OD PA Optometrist Past Accepting new patients

Locations

113 W Carpenter St
Benton, AR 72015
Phone (501) 778-2363

11115 Hermitage Rd
Little Rock, AR 72211
Phone (501) 224-7056

Organizations & group practices 4

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": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1508894304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2500",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720182500",
            "telephone_number": "501-778-2363",
            "fax_number": "501-778-5329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 W CARPENTER ST",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720153317",
            "telephone_number": "501-778-2363",
            "fax_number": "501-778-5329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "CREIGHTON",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, AR

Sources for this page

Verify at the official NPI Registry.