Individual provider Active NPI

Michael Cianca, OD

  • Optometrist
  • Brockton, MA
National Provider Identifier
1649798620
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5230 Issued in MA
Practice address
63 Main St
Brockton, MA 02301
Phone
(508) 559-6699
Fax
(508) 559-5073
NPI assigned
Aug 30, 2017
Last updated
Jun 11, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5230 MA Primary

Addresses

Primary practice location

63 Main St
Brockton, MA 02301

Mailing address

55 Dimock Street-Dimcok Community Health Center
Roxbury, MA 02119
Phone (617) 442-8800

Other practice location 1

55 Dimock Street
Roxbury, MA 02119-1029
Phone (617) 442-8800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20170912002668 MA Practitioner - Optometry 0941573034 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

63 Main St
Brockton, MA 02301-4042
Phone (508) 559-6699

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5230MAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Brockton Neighborhood Health Center CurrentSince Aug 25, 2018 Accepting new patients
Brockton Neighborhood Health Center, Inc. CurrentSince Aug 25, 2018 Accepting new patients

Locations

63 Main St
Brockton, MA 02301
Phone (508) 559-6696

Interoperability endpoints

  • FHIR API: https://epicproxy.et1290.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: mcianca18870@direct.ctc.masshiway.net

Organizations & group practices 2

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": "1504051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1649798620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 DIMOCK STREET-DIMCOK COMMUNITY HEALTH CENTER",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "02119",
            "telephone_number": "617-442-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 MAIN ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "02301",
            "telephone_number": "508-559-6699",
            "fax_number": "508-559-5073"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Dimock Street",
            "address_purpose": "LOCATION",
            "city": "Roxbury",
            "state": "MA",
            "postal_code": "021191029",
            "country_code": "US",
            "telephone_number": "617-442-8800",
            "fax_number": "617-442-8800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CIANCA",
        "first_name": "MICHAEL",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-30",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "5230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.