Active NPI
John V Rickman
- Optometrist
- Sublimity, OR
National Provider Identifier
1760447239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1724ATI
- Practice address
- 103 S Center Street
Suite D
Sublimity, OR 97385 - Phone
- (503) 769-9181
- Fax
- (503) 769-9182
- NPI assigned
- Apr 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1724ATI | OR | Primary |
| Optometrist | 152W00000X | 651 | AZ |
Addresses
Primary practice location
103 S Center Street
Suite D
Sublimity, OR 97385
Mailing address
PO Box 237
Sublimity, OR 97385-0237
Phone (503) 769-9181
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 107185 | Medicaid | OR |
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
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100407000064 | OR | Practitioner - Optometry | 9739215344 | Practice locations: Sublimity, OR |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Pacific University - College of Optometry, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
103 S Ctr St D
Sublimity, OR 97385-9101
Phone (503) 769-9181
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 70 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 651 | AZ | MD | Optometrist |
| 1724ATI | OR | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260403200000",
"number": "1760447239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 237",
"city": "SUBLIMITY",
"state": "OR",
"postal_code": "973850237",
"telephone_number": "503-769-9181",
"fax_number": "503-769-9182"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 S CENTER STREET",
"address_2": "SUITE D",
"city": "SUBLIMITY",
"state": "OR",
"postal_code": "97385",
"telephone_number": "503-769-9181",
"fax_number": "503-769-9182"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICKMAN",
"first_name": "JOHN",
"middle_name": "V",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-19",
"last_updated": "2009-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OR",
"license": "1724ATI",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AZ",
"license": "651",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "107185",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sublimity, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2009; 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.