Active NPI
Mary Grace Summers, O.D.
- Pediatric Optometrist
- Cordova, TN
National Provider Identifier
1780664706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Optometrist
- License
- 1429
- Practice address
- 8045 Club Pkwy
Cordova, TN 38016-5977 - Phone
- (901) 758-1384
- Fax
- (901) 758-1394
- NPI assigned
- Jan 17, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Optometrist | 152WP0200X | 1429 | TN | Primary |
Addresses
Primary practice location
8045 Club Pkwy
Cordova, TN 38016-5977
Mailing address
8045 Club Pkwy
Cordova, TN 38016-5977
Phone (901) 758-1384
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4092194 | Other | TN | BLUE CROSS BLUE SHIELD |
| 2240091 | Other | TN | UNITED HEALTH CARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vision Care | Past | Accepting new patients |
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Organizations & group practices 1
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.
-
- Optometrist
- Fountain Valley, CA
- NPI 1184920183
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453248000000",
"number": "1780664706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8045 CLUB PKWY",
"city": "CORDOVA",
"state": "TN",
"postal_code": "380165977",
"telephone_number": "901-758-1384",
"fax_number": "901-758-1394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8045 CLUB PKWY",
"city": "CORDOVA",
"state": "TN",
"postal_code": "380165977",
"telephone_number": "901-758-1384",
"fax_number": "901-758-1394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUMMERS",
"first_name": "MARY",
"middle_name": "GRACE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-01-17",
"last_updated": "2016-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "152WP0200X",
"taxonomy_group": "",
"desc": "Optometrist, Pediatrics",
"state": "TN",
"license": "1429",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "4092194",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "2240091",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cordova, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.