Individual provider Active NPI

Bao-Kim Cao Nguyen, OD

  • Optometrist
  • Boston, MA
National Provider Identifier
1619045929
Registry record updated Jul 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4526 Issued in MA
Practice address
175 Cambridge St
Boston, MA 02114-2743
Phone
(617) 523-5006
NPI assigned
Dec 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4526 MA Primary

Addresses

Primary practice location

175 Cambridge St
Boston, MA 02114-2743

Mailing address

120 Holmes Street
#209
Quincy, MA 02171
Phone (857) 526-1299

Other identifiers 1

IdentifierTypeStateIssuer
0705659MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20050926000174 MA Practitioner - Optometry 7810921228 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jeffrey Kublin OD PCGroup PAC ID 9537216361, 5 clinicians

Practice addresses (Care Compare)

175 Cambridge St
Boston, MA 02114-2743
Phone (617) 523-7006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4526MAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Jeffrey Kublin OD, PC Optometrist CurrentSince Mar 11, 2009 Accepting new patients
Pro Optical Optometrist Past Accepting new patients

Locations

175 Cambridge St
Boston, MA 02114
Phone (617) 523-7006

175 Cambridge St
Ste 130
Boston, MA 02114

Organizations & group practices 2

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": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246406400000",
    "number": "1619045929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 HOLMES STREET",
            "address_2": "#209",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "02171",
            "telephone_number": "857-526-1299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 CAMBRIDGE ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142743",
            "telephone_number": "617-523-5006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "BAO-KIM",
        "middle_name": "CAO",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-04",
        "last_updated": "2009-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0705659",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.