Kimberly Santillan, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2873 Issued in AR

Practice address

2783 N Shiloh Dr
Fayetteville, AR 72704-6983

Phone

(479) 442-8653

Fax

(479) 442-2678

NPI assigned

Jun 29, 2023

Last updated

Jun 29, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

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, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Triad Eye Institute PLLCGroup PAC ID 6507083557, 36 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ksantillan@triadeye.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.

• Triad Eye Institute PLLC

  • Ophthalmology Physician
  • Tulsa, OK
  • NPI 1093743213

  AR, Optometrist

  Medicare reassignment Care Compare group NPD
• Triad Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Fayetteville, AR
  • NPI 1851126197
  NPD (past)
• Triad Eye Institute PLLC

  • Ophthalmology Physician
  • Grove, OK
  • NPI 1912323247
  NPD (past)

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

{
    "created_epoch": "1687996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1780361907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2783 N SHILOH DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727046983",
            "telephone_number": "479-442-8653",
            "fax_number": "479-442-2678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2783 N SHILOH DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727046983",
            "telephone_number": "479-442-8653",
            "fax_number": "479-442-2678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTILLAN",
        "first_name": "KIMBERLY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-29",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jarret Sanders, MD
• Jerry Sanders, D.D.S.
• Sanders, Tompkins, Schiro, Landers and Sanders PLLC (Pediatric Dental Associates and Orthodontics)
• Robert Lee Sanderson, PA
• Garrett B Sanford, MD
• Carmela M Santos
• Anita A Sarathi, M.D.
• Jessica A Saravane, LMSW
• Michael Saravane
• Thomas A Sarna, D.D.S

• Optometrist in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Optometrist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 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.

Verify at the official NPI Registry.