Individual provider Active NPI

James Dylan Vaught, OD

  • Optometrist
  • Conway, SC
National Provider Identifier
1619224722
Registry record updated Dec 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1724 Issued in SC
Practice address
1406 Main St
Conway, SC 29526-3567
Phone
(843) 488-4147
Fax
(843) 488-0141
NPI assigned
Aug 8, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1724 SC Primary

Addresses

Primary practice location

1406 Main St
Conway, SC 29526-3567

Mailing address

1406 Main St
Conway, SC 29526-3567
Phone (843) 488-4147

Other identifiers 1

IdentifierTypeStateIssuer
D17248MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20120918000840 SC Practitioner - Optometry 6901054881 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vaught Eye Associates, PAGroup PAC ID 7416939715, 12 clinicians

Practice addresses (Care Compare)

1406 Main St
Conway, SC 29526-3567
Phone (843) 488-2020

Merit-based Incentive Payment System (MIPS)

Final score
76.34 of 100Reported as group
Quality
59.52
Improvement activities
40
Cost
75.09

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1724SCMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Vaught Eye Associates,PA CurrentSince Jul 1, 2012 Accepting new patients
Vaught Eye Associates, PA Optometrist CurrentSince Jul 30, 2012 Accepting new patients

Locations

1406 Main St
Conway, SC 29526
Phone (843) 488-2020

1400 Main St
Conway, SC 29526
Phone (803) 248-7272

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": "1344384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1619224722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 MAIN ST",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295263567",
            "telephone_number": "843-488-4147",
            "fax_number": "843-488-0141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 MAIN ST",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295263567",
            "telephone_number": "843-488-4147",
            "fax_number": "843-488-0141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHT",
        "first_name": "JAMES",
        "middle_name": "DYLAN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-08",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "1724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D17248",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, SC

Sources for this page

Verify at the official NPI Registry.