Individual provider Active NPI

Kathleen A Leary, O.D.

  • Optometrist
  • Reston, VA
National Provider Identifier
1598891418
Registry record updated Jun 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TA1318 Issued in MD
Practice address
11445 Sunset Hills Rd
Reston, VA 20190-5276
Phone
(703) 709-1500
Fax
(703) 709-1711
NPI assigned
Feb 26, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TA1318 MD Primary

Addresses

Primary practice location

11445 Sunset Hills Rd
Reston, VA 20190-5276

Mailing address

2101 E Jefferson St
Kaiser Permanente, Ppqa, 6 West, Attn: Theresa Brooks
Rockville, MD 20852-4908
Phone (301) 816-2424

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20091103000312 DC Practitioner - Optometry 8123166618 Reassigns benefits to 1 organization
I20191211002314 VA Practitioner - Optometry 8123166618 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kaiser Foundation Health Plan of the Mid Atlantic States, IncGroup PAC ID 3779495858, 1,921 clinicians

Practice addresses (Care Compare)

10701 Rosemary Dr
Manassas, VA 20109-7282
Phone (703) 257-3000

1221 Mercantile LN
Largo, MD 20774-5374
Phone (301) 618-5700

1890 Metro Ctr Dr
Reston, VA 20190-5286
Phone (703) 709-1500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TA1318MDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Sep 30, 2019 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Optometrist Current Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Aug 13, 2009 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Aug 13, 2009 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Optometrist Current Accepting new patients

Locations

2101 E Jefferson St
#4
Rockville, MD 20852

2101 E Jefferson St
Ste 4EAST
Rockville, MD 20852

2101 E Jefferson St
#6W
Rockville, MD 20852
Phone (301) 816-6660

2101 E Jefferson St
Ste 6WPPQA
Rockville, MD 20852
Phone (301) 816-5853

1221 Mercantile Ln
Upper Marlboro, MD 20774
Phone (301) 618-5500

10701 Rosemary Dr
Manassas, VA 20109
Phone (703) 257-3000

1890 Metro Center Dr
Reston, VA 20190
Phone (703) 709-1500

14139 Potomac Mills Rd
Woodbridge, VA 22192
Phone (703) 257-3000

Organizations & group practices 5

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": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1598891418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 E JEFFERSON ST",
            "address_2": "KAISER PERMANENTE, PPQA, 6 WEST, ATTN: THERESA BROOKS",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208524908",
            "telephone_number": "301-816-2424",
            "fax_number": "301-816-6308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11445 SUNSET HILLS RD",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201905276",
            "telephone_number": "703-709-1500",
            "fax_number": "703-709-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEARY",
        "first_name": "KATHLEEN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-26",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA1318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "11445 Sunset Hills Rd",
            "city": "Reston",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201905276",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Reston, VA

Sources for this page

Verify at the official NPI Registry.