NPIMap

Individual provider Active NPI

Nellie N Plummer, O.D.

  • Optometrist
  • Olympia Fields, IL
National Provider Identifier
1568717023
Registry record updated Jan 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046010603 Issued in IL
Practice address
20303 Crawford Ave
Olympia Fields, IL 60461-1073
Phone
(708) 898-1858
Fax
(708) 898-1860
NPI assigned
Jul 19, 2012
Last updated
Jan 11, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046010603 IL Primary

Addresses

Primary practice location

20303 Crawford Ave
Olympia Fields, IL 60461-1073

Mailing address

20303 Crawford Ave
Olympia Fields, IL 60461-1073
Phone (708) 898-1858

Other identifiers 3

IdentifierTypeStateIssuer
1636706OtherILBCBS
7235044OtherILAETNA
8825444OtherILMULTIPLAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121024000700 IL Practitioner - Optometry 9537319736 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Multack Eye Care, S.CGroup PAC ID 6507015138, 10 clinicians

Practice addresses (Care Compare)

20303 Crawford Ave
Suite LL1
Olympia Fields, IL 60461-1173
Phone (708) 955-9278

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Industrial Optical Service, Inc. Optometrist Past Accepting new patients
Industrial Optical Service, Inc. Optometrist Past Accepting new patients
Advanced Family Eyecare Center of Bolingbrook,Inc. Optometrist PastSince Dec 27, 2011 Accepting new patients
Industrial Optical Service, Inc. Optometrist Past Accepting new patients
Industrial Optical Service, Inc. Optometrist Past Accepting new patients
Myeyedr Optometry of Illinois, LLC Optometrist PastSince Feb 29, 2016 Accepting new patients
Industrial Optical Service, Inc. Optometrist Past Accepting new patients
Industrial Optical Service Inc Optometrist Past Accepting new patients
Industrial Optical Service, Inc. Optometrist Past Accepting new patients
Industrial Optical Service, Inc. Optometrist Past Accepting new patients
Industrial Optical Service, Inc. Optometrist Past Accepting new patients

Organizations & group practices 12

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1342656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484092800000",
    "number": "1568717023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20303 CRAWFORD AVE",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611073",
            "telephone_number": "708-898-1858",
            "fax_number": "708-898-1860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20303 CRAWFORD AVE",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611073",
            "telephone_number": "708-898-1858",
            "fax_number": "708-898-1860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PLUMMER",
        "first_name": "NELLIE",
        "middle_name": "N",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-19",
        "last_updated": "2017-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1636706",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7235044",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTIPLAN",
            "identifier": "8825444",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia Fields, IL

Sources for this page

Verify at the official NPI Registry.