Keith Brian Sparkman, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODT1603 Issued in TN

Practice address

1013 Spring Creek Rd
Chattanooga, TN 37412

Phone

(423) 855-8288

Fax

(423) 855-4527

NPI assigned

Dec 18, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

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 College of Optometry, 1994

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Keith B Sparkman

  • Optometrist
  • Chattanooga, TN
  • NPI 1548467194
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209340800000",
    "number": "1700949989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1013 SPRING CREEK RD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "37412",
            "telephone_number": "423-855-8288",
            "fax_number": "423-855-4527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 SPRING CREEK RD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "37412",
            "telephone_number": "423-855-8288",
            "fax_number": "423-855-4527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPARKMAN",
        "first_name": "KEITH",
        "middle_name": "BRIAN",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2008-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "ODT1603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH",
            "identifier": "2240306",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "3088639",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "410040394",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3599732",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Kathryn Spada
• Brian Richard Spalding, PHARM.D
• Jay Arthur Spalding, PHD
• Stephen Duane Spalding, MD
• John A Spann, DDS
• Christina Denine Sparks, PHD
• Eddie Lee Sparks
• Jennifer Keyes Sparks, NP-C
• Preston Avery Sparks, M.D.
• Susan R Sparks

• Optometrist in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2008; 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.