Russell Moss Gilliam, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

T1489 Issued in TN

Practice address

1022 S Miles Ave
Union City, TN 38261-5432

Phone

(731) 885-1049

Fax

(731) 885-6488

NPI assigned

Sep 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

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

Specialty

Optometry

Education

Southern California College of Optometry, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eyecare Center, LLCGroup PAC ID 9537231212, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: russgilliam@direct.revolutionehr.com

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.

• Eyecare Center, LLC

  • Optometrist
  • Martin, TN
  • NPI 1003082058
  Medicare reassignment Care Compare group NPD Authorized official
• Paris Eye Care, LLC

  • Optometrist
  • Paris, TN
  • NPI 1780626168
  NPD (past)

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689775520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1022 S MILES AVE",
            "city": "UNION CITY",
            "state": "TN",
            "postal_code": "382615432",
            "telephone_number": "731-885-1049",
            "fax_number": "731-885-6488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1022 S MILES AVE",
            "city": "UNION CITY",
            "state": "TN",
            "postal_code": "382615432",
            "telephone_number": "731-885-1049",
            "fax_number": "731-885-6488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLIAM",
        "first_name": "RUSSELL",
        "middle_name": "MOSS",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "T1489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0169173",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brenda Sue Frilling, LPN
• Chandler Fussell
• Dana C Fussell, LPTA
• Gabe Sullivan DDS PLC
• Melissa Gammons
• William Christopher Glover, ATC/L
• Hannah L Goodman, COTA/L
• Margaret Gore, M.D.
• Lalchand T Goyal, MD
• Molly Green, CCC-SLP

• Optometrist in Union City, TN
• Providers in Union City, TN by specialty
• Optometrist in Tennessee

• 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.