John Phillip Gysin, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

0046007961 Issued in IL

Practice address

5901 N Prospect Rd
Suite #11
Peoria, IL 61614-4358

Phone

(309) 692-2525

Fax

(309) 692-2584

NPI assigned

Aug 17, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bixby Eye Center IncGroup PAC ID 7012907892, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Bixby Eye Center PC

  • Optometrist
  • Peoria, IL
  • NPI 1326192626
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256688000000",
    "number": "1598757304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 N PROSPECT RD STE 11",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144337",
            "telephone_number": "309-692-2525",
            "fax_number": "309-692-2584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 N PROSPECT RD",
            "address_2": "SUITE #11",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144358",
            "telephone_number": "309-692-2525",
            "fax_number": "309-692-2584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GYSIN",
        "first_name": "JOHN",
        "middle_name": "PHILLIP",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-17",
        "last_updated": "2009-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "0046007961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046007961",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Martina Gustafson
• Amanda M Gutierrez
• Mario Gutierrez, M.D.
• Andrea Helene-Noelle Guyon, MD
• Susan Gwillim, PT
• Ellen Therese Haas, M.D.
• Sarah Haas, MSW, LCSW
• Stacy M Haas, SPEECH THERAPIST
• Terry Haas
• Connie Sue Haase, FNP-BC

• Optometrist in Peoria, IL
• Providers in Peoria, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2009; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.