Active NPI
Poonam Pannu, OD
- Optometrist
- Albany, OR
National Provider Identifier
1710662226
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- ATI4682
- Practice address
- 2330 Heritage Way SE
Albany, OR 97322-8600 - Phone
- (541) 926-6077
- Fax
- (541) 926-0605
- NPI assigned
- Jun 21, 2023
- Last updated
- Jun 21, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | ATI4682 | OR | Primary |
Addresses
Primary practice location
2330 Heritage Way SE
Albany, OR 97322-8600
Mailing address
2330 Heritage Way SE
Albany, OR 97322-8600
Phone (541) 926-6077
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Pacific University - College of Optometry, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2330 Heritage Ave SE
Albany, OR 97322-8600
Phone (541) 926-6077
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ATI4682 | OR | MD | Optometrist |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Optometrist
- Albany, OR
- NPI 1689898694
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687305600000",
"number": "1710662226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2330 HERITAGE WAY SE",
"city": "ALBANY",
"state": "OR",
"postal_code": "973228600",
"telephone_number": "541-926-6077",
"fax_number": "541-926-0605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2330 HERITAGE WAY SE",
"city": "ALBANY",
"state": "OR",
"postal_code": "973228600",
"telephone_number": "541-926-6077",
"fax_number": "541-926-0605"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANNU",
"first_name": "POONAM",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-06-21",
"last_updated": "2023-06-21",
"certification_date": "2023-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OR",
"license": "ATI4682",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albany, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; 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.