Individual provider Active NPI

Shari L Coolbaugh, OD

  • Optometrist
  • Roanoke, VA
National Provider Identifier
1649277229
Registry record updated Feb 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0601002108 Issued in VA
Practice address
1960 Electric Rd
Roanoke, VA 24018-1621
Phone
(540) 772-7171
Fax
(540) 774-8299
NPI assigned
Jun 28, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 0601002108 VA Primary

Addresses

Primary practice location

1960 Electric Rd
Roanoke, VA 24018-1621

Mailing address

1960 Electric Rd
Roanoke, VA 24018-1621
Phone (540) 772-7171

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20060112000318 VA Practitioner - Optometry 1052334380 Reassigns benefits to 1 organization
Practice locations: Roanoke, VA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Care and Surgery PCGroup PAC ID 3678666096, 8 clinicians

Practice addresses (Care Compare)

1960 Electric Rd
Roanoke, VA 24018-1601
Phone (540) 772-0870

Merit-based Incentive Payment System (MIPS)

Final score
83.69 of 100Reported as group
Quality
100
Improvement activities
40
Cost
45.64

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0601002108VAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Care & Surgery PC CurrentSince Sep 11, 1996 Accepting new patients

Locations

13295 Booker T Washington Hwy
Hardy, VA 24101
Phone (540) 721-4433

1960 Electric Rd
Roanoke, VA 24018
Phone (540) 772-0870

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266537600000",
    "number": "1649277229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1960 ELECTRIC RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240181621",
            "telephone_number": "540-772-7171",
            "fax_number": "540-774-8299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1960 ELECTRIC RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240181621",
            "telephone_number": "540-772-7171",
            "fax_number": "540-774-8299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOLBAUGH",
        "first_name": "SHARI",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-28",
        "last_updated": "2010-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0601002108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

Verify at the official NPI Registry.