Individual provider Active NPI

Kevin Pugh, OD

  • Optometrist
  • Mesa, AZ
National Provider Identifier
1568845097
Registry record updated Feb 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2054 Issued in AZ
Practice address
1055 S Stapley Dr
Mesa, AZ 85204
Phone
(480) 833-9100
Fax
(480) 833-6000
NPI assigned
Jul 1, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2054 AZ Primary

Addresses

Primary practice location

1055 S Stapley Dr
Mesa, AZ 85204

Mailing address

4800 N 22ND St Ste 210
Phoenix, AZ 85016-4963
Phone (480) 892-8400

Other practice location 1

1055 S Stapley Dr
Mesa, AZ 85204-5098
Phone (480) 833-9100

Other identifiers 1

IdentifierTypeStateIssuer
032451MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20150716003071 AZ Practitioner - Optometry 5193038305 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southwestern Eye Center LTDGroup PAC ID 1850296989, 116 clinicians

Practice addresses (Care Compare)

4760 E Falcon Dr
Suite 101
Mesa, AZ 85215-2528
Phone (480) 985-7400

Merit-based Incentive Payment System (MIPS)

Final score
88.66 of 100Reported as group
Quality
84.9
Promoting interoperability
100
Improvement activities
40
Cost
77.31

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2054AZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southwestern Eye Center LTD Current Accepting new patients
Southwestern Eye Center, LTD Optometrist CurrentSince Nov 1, 2018 Accepting new patients
Southwestern Eye Center, LTD Optometrist CurrentSince Nov 1, 2018 Accepting new patients
Barnet Dulaney Perkins Eye Center, PC CurrentSince Nov 1, 2018 Accepting new patients
Barnet Dulaney Perkins Eye Center, PC CurrentSince Nov 1, 2018 Accepting new patients
Barnet Dulaney Perkins Eye Center, PC Current Accepting new patients
Eye Guys Optometrist PastSince Sep 24, 2023 Accepting new patients

Locations

41810 N Venture Dr
Ste E152
Anthem, AZ 85086
Phone (623) 584-9295

3003 Highway 95
Ste 63
Bullhead City, AZ 86442
Phone (928) 763-7555

270 S Candy Ln
Cottonwood, AZ 86326
Phone (928) 634-4202

5285 W Bell Rd
Ste 110
Glendale, AZ 85308
Phone (602) 903-0922

1055 S Stapley Dr
Mesa, AZ 85204
Phone (480) 833-9100

5250 E Southern Ave
Mesa, AZ 85206
Phone (480) 420-1005

1121 S Gilbert Rd
Ste 103
Mesa, AZ 85204
Phone (480) 459-8500

7435 E Main St
Ste 101
Mesa, AZ 85207
Phone (480) 634-3777

4760 E Falcon Dr
Ste 101
Mesa, AZ 85215
Phone (480) 985-7400

6705 E McDowell Rd
Mesa, AZ 85215
Phone (480) 985-7400

4800 N 22nd St
Ste 210
Phoenix, AZ 85016
Phone (602) 598-7488

4800 N 22nd St
Ste 120
Phoenix, AZ 85016

4800 N 22nd St
Phoenix, AZ 85016
Phone (602) 508-4843

13215 N 7th St
Phoenix, AZ 85022

2370 W State Route 89A
Ste 16A17A18
Sedona, AZ 86336
Phone (928) 282-1231

13624 W Camino del Sol
Ste 200
Sun City West, AZ 85375
Phone (623) 546-6599

698 E Wetmore Rd
Ste 100
Tucson, AZ 85705
Phone (520) 690-5707

5632 E 5th St
Tucson, AZ 85711
Phone (520) 584-8888

2149 W 24th St
Yuma, AZ 85364
Phone (928) 726-1100

Interoperability endpoints

  • Direct secure messaging: kevin.pugh@direct.avp.nextgenshare.com
  • Direct secure messaging: kevin.pugh.p11@direct.avp.nextgenshare.com

Organizations & group practices 7

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": "1435708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708646400000",
    "number": "1568845097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 N 22ND ST STE 210",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850164963",
            "telephone_number": "480-892-8400",
            "fax_number": "602-508-4830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 S STAPLEY DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85204",
            "telephone_number": "480-833-9100",
            "fax_number": "480-833-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1055 S Stapley Dr",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852045098",
            "country_code": "US",
            "telephone_number": "480-833-9100",
            "fax_number": "602-508-4830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PUGH",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-01",
        "last_updated": "2024-02-23",
        "certification_date": "2021-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "2054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "032451",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.