Individual provider Active NPI

George D Bertherman, O.D

  • Optometrist
  • Providence, RI
National Provider Identifier
1629074141
Registry record updated Apr 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ODTG00481 Issued in RI
Practice address
1466 Broad St
Providence, RI 02905-2836
Phone
(401) 941-6221
Fax
(401) 941-6227
NPI assigned
Jun 21, 2005
Last updated
Apr 1, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X ODTG00481 RI Primary

Addresses

Primary practice location

1466 Broad St
Providence, RI 02905-2836

Mailing address

1466 Broad St
Providence, RI 02905-2836
Phone (401) 941-6221

Other identifiers 1

IdentifierTypeStateIssuer
GB25798MedicaidRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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
I20070618000142 RI Practitioner - Optometry 5294834271 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
George D Bertherman,O.D., Inc.Group PAC ID 1355441858, 3 clinicians

Practice addresses (Care Compare)

1466 Broad St
Providence, RI 02905-2836

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ODTG00481RIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
George D. Bertherman,O.D., Inc. Optometrist CurrentSince Sep 5, 2006 Accepting new patients

Locations

1466 Broad St
Providence, RI 02905
Phone (401) 441-6221

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207008000000",
    "number": "1629074141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1466 BROAD ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029052836",
            "telephone_number": "401-941-6221",
            "fax_number": "401-941-6227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1466 BROAD ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029052836",
            "telephone_number": "401-941-6221",
            "fax_number": "401-941-6227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTHERMAN",
        "first_name": "GEORGE",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "O.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2008-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "RI",
            "license": "ODTG00481",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GB25798",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.