Greater Lafayette Retina Center, P.C.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

01057576A Issued in IN

Legal business name

GREATER LAFAYETTE RETINA CENTER, P.C.

Practice address

1013 N 13TH St
Lafayette, IN 47904-2011

Phone

(765) 428-8888

Fax

(765) 428-8889

NPI assigned

May 3, 2007

Last updated

Jun 27, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Phyllis M. Watkins

Title

Billing Department

Phone

(765) 428-8888

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rodney B. Kusumi, M.D.

  • Ophthalmology Physician
  • Lafayette, IN
  • NPI 1265458160
  Medicare reassignment
• Robert A Maines, RN

  • Administrator Registered Nurse
  • Lafayette, IN
  • NPI 1720387921
  NPD (past)
• Cynthia Kay Whited, CST/CSFA

  • Surgical Technologist
  • Lafayette, IN
  • NPI 1780871673
  NPD (past)

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403827200000",
    "number": "1629280813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1013 N 13TH ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479042011",
            "telephone_number": "765-428-8888",
            "fax_number": "765-428-8889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 N 13TH ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479042011",
            "telephone_number": "765-428-8888",
            "fax_number": "765-428-8889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER LAFAYETTE RETINA CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2014-06-27",
        "status": "A",
        "authorized_official_last_name": "WATKINS",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "BILLING DEPARTMENT",
        "authorized_official_telephone_number": "765-428-8888"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IN",
            "license": "01057576A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "POO176469",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "01057576A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200441070",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Greater Lafayette Health Services (Franciscan St. Elizabeth Health-Lafayette Central)
• Greater Lafayette Health Services (Faith, Hope, and Love Cancer Center)
• Greater Lafayette Health Services (Dialysis Center of Lafayette)
• Greater Lafayette Health Services (Innervision Advanced Medical Imaging)
• Greater Lafayette Health Services (Unity Surgical Center)
• Cindy Sue Green-Smith, LCSW
• Adriana Green, FNP-BC
• Kelli Ann Greene, MSW, LCSW
• Linda C Gregor, PT
• Beth Gretencord, CPSP

• Ophthalmology Physician in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Ophthalmology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.