Active NPI
Jennifer Elhabiby, OD
- Optometrist
- Buckeye, AZ
National Provider Identifier
1568433787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1209
- Practice address
- 1111 N Verrado Way
Buckeye, AZ 85326-6795 - Phone
- (480) 618-4015
- NPI assigned
- Jan 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT-001209 | AZ | |
| Optometrist | 152W00000X | 1209 | AZ | Primary |
Addresses
Primary practice location
1111 N Verrado Way
Buckeye, AZ 85326-6795
Mailing address
1111 N Verrado Way
Buckeye, AZ 85326-6795
Phone (480) 618-4015
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 5, 2024 through Mar 5, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1209 | AZ | MD | Neurology Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719446400000",
"number": "1568433787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 N VERRADO WAY",
"city": "BUCKEYE",
"state": "AZ",
"postal_code": "853266795",
"telephone_number": "480-618-4015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 N VERRADO WAY",
"city": "BUCKEYE",
"state": "AZ",
"postal_code": "853266795",
"telephone_number": "480-618-4015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELHABIBY",
"first_name": "JENNIFER",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-27",
"last_updated": "2024-06-27",
"certification_date": "2024-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AZ",
"license": "OPT-001209",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AZ",
"license": "1209",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buckeye, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.