NPIMap

Individual provider Active NPI

Robert J. Kupsho Jr., O.D.

  • Optometrist
  • Hazle Township, PA
National Provider Identifier
1780644872
Registry record updated Aug 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG000548 Issued in PA
Practice address
426 Airport Rd
Hazle Township, PA 18202-3361
Phone
(570) 459-9730
Fax
(570) 459-9736
NPI assigned
Mar 24, 2006
Last updated
Aug 25, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OEG000548 PA Primary

Addresses

Primary practice location

426 Airport Rd
Hazle Township, PA 18202-3361

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144

Other identifiers 1

IdentifierTypeStateIssuer
0013986700005MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rkupsho63017@direct.geisinger.edu Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050531000924 PA Practitioner - Optometry 4789626748 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

100 N Academy Ave
Danville, PA 17822-9800
Phone (570) 271-6144

2200 W Front St
GMG Berwick
Berwick, PA 18603-4106
Phone (570) 759-2017

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic CurrentSince Jul 1, 2005 Accepting new patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic CurrentSince Jul 1, 2005 Accepting new patients
Caring Community Health Center CurrentSince Nov 12, 2019 Accepting new patients
Caring Community Health Center CurrentSince Nov 12, 2019 Accepting new patients
Geisinger Clinic Past Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

426 Airport Rd
Hazle Township, PA 18202
Phone (570) 453-0172

426 Airport Rd
Ste 125
Hazle Township, PA 18202
Phone (570) 829-2621

56 Jam House Rd
Mifflin, PA 17058
Phone (717) 436-8986

Interoperability endpoints

  • Direct secure messaging: rkupsho63017@direct.geisinger.edu

Organizations & group practices 6

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.

Hospital & facility affiliations 26

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598313600000",
    "number": "1780644872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "426 AIRPORT RD",
            "city": "HAZLE TOWNSHIP",
            "state": "PA",
            "postal_code": "182023361",
            "telephone_number": "570-459-9730",
            "fax_number": "570-459-9736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUPSHO",
        "first_name": "ROBERT",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2020-08-25",
        "certification_date": "2020-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0013986700005",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rkupsho63017@direct.geisinger.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "426 Airport Rd",
            "city": "Hazle Township",
            "state": "PA",
            "country_code": "US",
            "postal_code": "182023361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hazle Township, PA

Sources for this page

Verify at the official NPI Registry.