Individual provider Active NPI

Scott E Johnson, O.D.

  • Optometrist
  • Blytheville, AR
National Provider Identifier
1689640310
Registry record updated Dec 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2479 Issued in AR
Practice address
1005 N 6TH St
Blytheville, AR 72315-1707
Phone
(870) 763-0760
Fax
(870) 838-1051
NPI assigned
Feb 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2479 AR Primary

Addresses

Primary practice location

1005 N 6TH St
Blytheville, AR 72315-1707

Mailing address

1005 N 6TH St
Blytheville, AR 72315-1707
Phone (870) 763-0760

Other identifiers 1

IdentifierTypeStateIssuer
134450722MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20101004001001 AR Practitioner - Optometry 2264549344 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1005 N 6TH St
Blytheville, AR 72315-1707
Phone (870) 763-0760

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery15

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2479ARMDDentist
2473ARMDPediatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Scott Johnson Visioncare, P.a. Optometrist CurrentSince May 3, 2003 Accepting new patients

Locations

1005 N 6th St
Blytheville, AR 72315
Phone (870) 763-0760

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": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386028800000",
    "number": "1689640310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 N 6TH ST",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723151707",
            "telephone_number": "870-763-0760",
            "fax_number": "870-838-1051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 N 6TH ST",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723151707",
            "telephone_number": "870-763-0760",
            "fax_number": "870-838-1051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SCOTT",
        "middle_name": "E",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-23",
        "last_updated": "2013-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "134450722",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blytheville, AR

Sources for this page

Verify at the official NPI Registry.