Ellen Kay Braley, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046.011451 Issued in IL

Practice address

300 N Broad St
Carlinville, IL 62626-1304

Phone

(217) 854-7611

Fax

(217) 854-8120

NPI assigned

Jul 9, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ellen K Sullivan Former name

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

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Charles S Ovitsky PCGroup PAC ID 7012175102, 14 clinicians

Practice addresses (Care Compare)

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.

• Charles S Ovitsky PC

  • Optometrist
  • Chicago, IL
  • NPI 1568647220
  Medicare reassignment Care Compare group NPD
• Eyecare of Carlinville PC

  • Optometrist
  • Carlinville, IL
  • NPI 1578803011
  Medicare reassignment NPD
• Carlinville Eye Care PC

  • Optometrist
  • Carlinville, IL
  • NPI 1841392768
  NPD (past)

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

{
    "created_epoch": "1594252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594252800000",
    "number": "1619595352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 N BROAD ST",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626261304",
            "telephone_number": "217-854-7611",
            "fax_number": "217-854-8120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N BROAD ST",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626261304",
            "telephone_number": "217-854-7611",
            "fax_number": "217-854-8120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRALEY",
        "first_name": "ELLEN",
        "middle_name": "KAY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-09",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.011451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELLEN",
            "last_name": "SULLIVAN",
            "middle_name": "K",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Wayne Blevins Jr.
• Katherine Boente, D.M.D.
• Steven John Boente, D.M.D.
• Kaitlin E Borgini
• Katelyn Elizabeth Bormida, M.S., CCC-SLP
• Joan Brown
• Kristin Buller, LCSW
• Samantha Butcher, OD
• Calloway Chiropractic PC
• Kelly Anne Calloway, DC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; 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.