Collaborative Care Medical Associates Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1120DT Issued in KY

Legal business name

COLLABORATIVE CARE MEDICAL ASSOCIATES INC.

Practice address

941 N Main St
Hazard, KY 41701-1377

Phone

(606) 439-4010

Fax

(606) 439-0880

NPI assigned

Dec 10, 2009

Last updated

Jan 24, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dwight L Avery, O.D.NPI 1992883243

Title

Owner

Phone

(606) 439-4010

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dwight L Avery, OD

  • Optometrist
  • Hazard, KY
  • NPI 1992883243
  Medicare reassignment NPD Authorized official
• Nadine Brock, APRN

  • Nurse Practitioner
  • London, KY
  • NPI 1285800938
  NPD (past)

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

{
    "created_epoch": "1260403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295827200000",
    "number": "1558690180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "941 N MAIN ST",
            "city": "HAZARD",
            "state": "KY",
            "postal_code": "417011377",
            "telephone_number": "606-439-4010",
            "fax_number": "606-439-0880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "941 N MAIN ST",
            "city": "HAZARD",
            "state": "KY",
            "postal_code": "417011377",
            "telephone_number": "606-439-4010",
            "fax_number": "606-439-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLABORATIVE CARE MEDICAL ASSOCIATES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-10",
        "last_updated": "2011-01-24",
        "status": "A",
        "authorized_official_last_name": "AVERY",
        "authorized_official_first_name": "DWIGHT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-439-4010",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "5556P",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1120DT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sonja Cochran
• Amy Cole
• Thomas Chester Cole
• Brian Scott Coleman
• Crystal Dawn Coleman, APRN
• Amanda Irene Collett, FNP-BC
• Deborah S Collier, DMD
• Ellen Lee Collins
• Jaime Collins
• Lori Collins

• Optometrist in Hazard, KY
• Providers in Hazard, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; 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.