Michael James Bangert, MICHAEL BANGERT, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

18001776B Issued in IN

Practice address

4626 W Jefferson Blvd
Fort Wayne, IN 46804-6826

Phone

(260) 432-5502

Fax

(260) 432-8415

NPI assigned

Jan 26, 2007

Sex

Male

Sole proprietor

No

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.

• Apple Eyecare FW Southwest LLC

  • Optometrist
  • Fort Wayne, IN
  • NPI 1285375014

  IN, Optometrist

  Medicare reassignment NPD

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

• Dr. Michael James Bangert Other name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 30, 2013.

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375142400000",
    "number": "1629124151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4626 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046826",
            "telephone_number": "260-432-5502",
            "fax_number": "260-432-8415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4626 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046826",
            "telephone_number": "260-432-5502",
            "fax_number": "260-432-8415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANGERT",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "MICHAEL BANGERT, OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2013-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18001776B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RETIRED RAILROAD MEDICARE",
            "identifier": "410005869",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHAEL",
            "last_name": "BANGERT",
            "middle_name": "JAMES",
            "prefix": "DR.",
            "credential": "MICHAEL BANGERT O.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Bandaidsplus, LLC
• Stephanie R Bandy, DPT, ATC
• Tabitha J Bane
• Ashley Baney
• Jill A. Baney, NP
• Gregory M. Banicki, M.S. ED.
• Maegan Banicki
• Jakyria Monae-Tyree Banks
• Regan J Banks, MS ED
• Amanjit Kaur Banwait

• All providers in Fort Wayne, IN
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.