Individual provider Active NPI

Samantha Marie Bertherman, OD

  • Optometrist
  • Providence, RI
National Provider Identifier
1790353308
Registry record updated Jun 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ODTG00717 Issued in RI
Practice address
1466 Broad St
Providence, RI 02905-2836
Phone
(401) 941-6221
NPI assigned
Jun 11, 2021
Last updated
Jun 25, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Optometrist 152W00000X ODTG00717 RI Primary

Addresses

Primary practice location

1466 Broad St
Providence, RI 02905-2836

Mailing address

9 Oak Ridge Dr
Cumberland, RI 02864-3534
Phone (401) 595-8695

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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

Enrollment IDStateProvider typePAC IDDetails
I20210713001989 RI Practitioner - Optometry 4688076623 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
George D Bertherman,O.D., Inc.Group PAC ID 1355441858, 3 clinicians

Practice addresses (Care Compare)

1466 Broad St
Providence, RI 02905-2836
Phone (401) 941-6221

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
George D. Bertherman,O.D., Inc. Optometrist CurrentSince Jul 12, 2021 Accepting new patients

Locations

1466 Broad St
Providence, RI 02905
Phone (401) 441-6221

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1623369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624579200000",
    "number": "1790353308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 OAK RIDGE DR",
            "city": "CUMBERLAND",
            "state": "RI",
            "postal_code": "028643534",
            "telephone_number": "401-595-8695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1466 BROAD ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029052836",
            "telephone_number": "401-941-6221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTHERMAN",
        "first_name": "SAMANTHA",
        "middle_name": "MARIE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-11",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "RI",
            "license": "ODTG00717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.