Active NPI
Kenneth Bellucci, O.D.
- Optometrist
- Tewksbury, MA
National Provider Identifier
1639275266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2886
- Practice address
- 1445 Main St
Tewksbury, MA 01876-4723 - Phone
- (978) 851-3818
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2886 | MA | Primary |
Addresses
Primary practice location
1445 Main St
Tewksbury, MA 01876-4723
Mailing address
1445 Main St
Tewksbury, MA 01876-4723
Phone (978) 851-3818
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03119 | Other | MA | SPECTERA |
| 34922 | Other | MA | DAVIS VISION |
| 0341584 | Medicaid | MA | |
| W15536 | Other | MA | BLUE CROSS/BLUE SCHIELD |
| 152049 | Other | MA | HARVARD HEALTH CARE |
| 705042 | Other | MA | TUFTS HEALTH CARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639275266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1445 MAIN ST",
"city": "TEWKSBURY",
"state": "MA",
"postal_code": "018764723",
"telephone_number": "978-851-3818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1445 MAIN ST",
"city": "TEWKSBURY",
"state": "MA",
"postal_code": "018764723",
"telephone_number": "978-851-3818"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BELLUCCI",
"first_name": "KENNETH",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MA",
"license": "2886",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPECTERA",
"identifier": "03119",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DAVIS VISION",
"identifier": "34922",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0341584",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SCHIELD",
"identifier": "W15536",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD HEALTH CARE",
"identifier": "152049",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH CARE",
"identifier": "705042",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tewksbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.