Individual provider Active NPI

Emmeline Siebert

  • Optometrist
  • Centennial, CO
National Provider Identifier
1720514979
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT.0003990 Issued in CO
Practice address
5555 E Arapahoe Rd
Centennial, CO 80122-2312
Phone
(303) 338-3800
NPI assigned
May 10, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5301 MA
Optometrist 152W00000X OPT.0003990 CO Primary

Addresses

Primary practice location

5555 E Arapahoe Rd
Centennial, CO 80122-2312

Mailing address

10350 E Dakota Ave
Denver, CO 80247-1314
Phone (303) 338-3800

Other names 1

  • Emmeline Cruz Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address Cruz.Emmeline.OCB@direct.partners.masshiway.net Health Information Exchange (HIE)
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, CO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20180830002133 MA Practitioner - Optometry 6608126362 Reassigns benefits to 1 organization
I20250303002922 CO Practitioner - Optometry 6608126362 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of California - School of Optometry, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Colorado Permanente Medical Group PCGroup PAC ID 1254238454, 1,325 clinicians

Practice addresses (Care Compare)

5555 E Arapahoe Rd
Kaiser Permanente Arapahoe Medical
Centennial, CO 80122-2312
Phone (303) 338-4545

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5301MAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Colorado Permanente Medical Group, P.C. CurrentSince Dec 28, 2024 Accepting new patients
Upham'S Corner Health Committee, Inc. CurrentSince Oct 20, 2018 Accepting new patients

Locations

10350 E Dakota Ave
Denver, CO 80247
Phone (303) 636-3350

5555 E Arapahoe Rd
Littleton, CO 80122
Phone (303) 850-2111

415 Columbia Rd
Uphams Corner, MA 02125
Phone (617) 287-8000

500 Columbia Rd
Uphams Corner, MA 02125
Phone (617) 287-8000

Interoperability endpoints

  • Direct secure messaging: cruz.emmeline.ocb@direct.partners.masshiway.net

Organizations & group practices 2

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": "1494374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1720514979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10350 E DAKOTA AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802471314",
            "telephone_number": "303-338-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 E ARAPAHOE RD",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801222312",
            "telephone_number": "303-338-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIEBERT",
        "first_name": "EMMELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-10",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "5301",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "OPT.0003990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Cruz.Emmeline.OCB@direct.partners.masshiway.net",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "50 Staniford St Ste 600",
            "city": "Boston",
            "state": "MA",
            "country_code": "US",
            "postal_code": "021142587",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5555 E Arapahoe Rd",
            "city": "Centennial",
            "state": "CO",
            "country_code": "US",
            "postal_code": "801222312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "EMMELINE",
            "last_name": "CRUZ",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Centennial, CO

Sources for this page

Verify at the official NPI Registry.