NPIMap

Individual provider Active NPI

Michael Lee Stark, DO

  • Ophthalmology Physician
  • Sidney, OH
National Provider Identifier
1679579577
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
3380 Issued in OH
Practice address
1118 Fairington Dr
Sidney, OH 45365-8913
Phone
(937) 492-3755
Fax
(937) 492-1132
NPI assigned
Jun 24, 2005
Last updated
Sep 16, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 3380 OH Primary

Addresses

Primary practice location

1118 Fairington Dr
Sidney, OH 45365-8913

Mailing address

4445 Lake Forest Dr Ste 600
Blue Ash, OH 45242-3744
Phone (513) 569-3741

Other identifiers 1

IdentifierTypeStateIssuer
0533462MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040202000618 OH Practitioner - Ophthalmology 7214830611 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
93.01 of 100Reported as apm
Quality
86.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
3380OHMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Cei Physicians PSC, LLC CurrentSince Dec 15, 2020 Accepting new patients
Cei Physicians PSC LLC Ophthalmology CurrentSince Dec 15, 2020 Accepting new patients
JTDM Family Practice LLC Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Valley Eye Institute Past Accepting new patients
Valley Eye Institute Past Accepting new patients
Valley Eye Institute Past Accepting new patients
Valley Eye Institute ASC LLC PastSince Jun 19, 2003 Accepting new patients
Eye Care & Surgery Assoc., Inc. Ophthalmology Past Accepting new patients

Locations

1945 Cei Dr
Blue Ash, OH 45242

1219 Recker Rd
Piqua, OH 45356
Phone (937) 492-3755

1118 Fairington Dr
Sidney, OH 45365
Phone (937) 492-3755

180 S Stanfield Rd
Troy, OH 45373
Phone (937) 335-3933

Interoperability endpoints

  • Direct secure messaging: michael.stark.p1@direct.cei.nextgenshare.com

Organizations & group practices 10

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": "1119571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1679579577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4445 LAKE FOREST DR STE 600",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452423744",
            "telephone_number": "513-569-3741",
            "fax_number": "937-492-1132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 FAIRINGTON DR",
            "city": "SIDNEY",
            "state": "OH",
            "postal_code": "453658913",
            "telephone_number": "937-492-3755",
            "fax_number": "937-492-1132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "MICHAEL",
        "middle_name": "LEE",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-24",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OH",
            "license": "3380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0533462",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sidney, OH

Sources for this page

Verify at the official NPI Registry.