Kristanza Marie Bronnenberg, OD
Individual provider Active NPI Optometrist · Cody, WY
NPI 1801437140 · NPPES record last updated Dec 18, 2020
Key facts
- NPI
- 1801437140
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 429T (WY)
- Practice address
- 620 19TH St
Cody, WY 82414-3305 - Phone
- (307) 587-4206
- Fax
- (307) 587-5539
- NPI assigned
- Oct 7, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern California College of Optometry, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Basin Vision Center, P. C.
Practice addresses (Care Compare)
620 19TH St
Cody, WY 82414-3305
Phone (307) 587-4206
Hospital & facility affiliations
- Cody Regional Health
Merit-based Incentive Payment System (MIPS)
- Final score
- 65 of 100
- Quality
- 30
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 14 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200714003813 | WY | Practitioner - Optometry | 6002239639 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 429T | WY | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Basin Vision Center, P. C. | Optometrist | Current |
Accepting new patients |
Locations
1531 Bleistein Ave
Cody, WY 82414
Phone (307) 587-4206
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 429T | WY | Yes |
Addresses
Primary practice location
620 19TH St
Cody, WY 82414-3305
Mailing address
PO Box 2810
Cody, WY 82414-2810
Phone (307) 587-4206
Other practice location 1
5460 E La Palma Ave
Anaheim, CA 92807-2023
Phone (714) 463-7500
Other providers in Cody, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.