Cory J. Bosanko, O.D.

Primary specialty

Low Vision Rehabilitation OptometristTaxonomy code 152WL0500X

License

OD0000002541 Issued in TN

Practice address

39 Lantana Rd
Crossville, TN 38555-4901

Phone

(931) 484-3344

Fax

(931) 456-3671

NPI assigned

Aug 2, 2005

Last updated

Jan 22, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

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

Illinois College of Optometry at Chicago, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cookeville Eye Specialists, PLLCGroup PAC ID 5294757985, 6 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

82.57 of 100Reported as group

Quality

98.5

Improvement activities

40

Cost

43.89

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cbosanko@esp.intellechartdirect.net

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.

• Cookeville Eye Specialists, PLLC

  • Optometrist
  • Cookeville, TN
  • NPI 1033254289
  Medicare reassignment Care Compare group NPD
• Cookeville Eye Specialists, PLLC

  • Durable Medical Equipment & Medical Supplies
  • Crossville, TN
  • NPI 1316540487

  Optometrist

  NPD
• Eye Centers of Tennessee, LLC

  • Ophthalmology Physician
  • Crossville, TN
  • NPI 1104940790

  Optometrist

  NPD
• Gainesville Eye Associates LLC

  • Ophthalmology Physician
  • Gainesville, GA
  • NPI 1285617647

  Optometrist

  NPD
• Eye Centers of Tennessee, LLC

  • Optometrist
  • Livingston, TN
  • NPI 1134243751
  NPD (past)
• Tennessee Primary Care, LLC

  • Rural Health Clinic/Center
  • Cookeville, TN
  • NPI 1669367322
  NPD (past)

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611273600000",
    "number": "1730180704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 LANTANA RD",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385554901",
            "telephone_number": "931-484-3344",
            "fax_number": "931-456-3671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 LANTANA RD",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385554901",
            "telephone_number": "931-484-3344",
            "fax_number": "931-456-3671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSANKO",
        "first_name": "CORY",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-02",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "OD2541",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "TN",
            "license": "OD0000002541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3946606",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3943261",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST",
            "identifier": "4109506",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Bolton, MD
• William Christopher Bonine, H.I.S.
• Bonom Anesthesia
• Kelly Borden, FNP-C
• Kimberly Ann Boring, FNP
• Renee Thompson Boston, PA
• Kristine K Bour
• Rita H Bowlin, RN
• Lia C Boyanton, MD
• Lori McPhail Boyd, O.D.

• Low Vision Rehabilitation Optometrist in Crossville, TN
• Providers in Crossville, TN by specialty
• Low Vision Rehabilitation Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; 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.