NPIMap

Organization Active NPI

Northwest Optometry Group, P.a.

  • Optometrist
  • Sparta, NJ
National Provider Identifier
1801853254
Registry record updated Sep 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
NORTHWEST OPTOMETRY GROUP, P.A.
Practice address
117 Sparta Ave
Sparta, NJ 07871-1773
Phone
(973) 729-9199
Fax
(973) 729-9260
NPI assigned
Apr 28, 2006
Last updated
Sep 23, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2013

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

Authorized official

Name
Dr. Bernard Mullin, O.D.NPI 1487650354
Title
V.P.
Phone
(908) 832-9211

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

117 Sparta Ave
Sparta, NJ 07871-1773

Mailing address

117 Sparta Ave
Sparta, NJ 07871-1773
Phone (973) 729-9199

Other identifiers 6

IdentifierTypeStateIssuer
331420102MedicaidNJ
331420106MedicaidNJ
331420104MedicaidNJ
331420105MedicaidNJ
CD9470OtherRAILROAD MEDICARE
331420103MedicaidNJ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051222000270 NJ Part B Supplier - Clinic/Group Practice 0648296418 Receives reassigned benefits from 8 practitioners
Practice locations: Blairstown, NJ; Branchville, NJ; Califon, NJ; Sparta, NJ; Stanhope, NJ

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 5

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379894400000",
    "number": "1801853254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 SPARTA AVE",
            "city": "SPARTA",
            "state": "NJ",
            "postal_code": "078711773",
            "telephone_number": "973-729-9199",
            "fax_number": "973-729-9260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 SPARTA AVE",
            "city": "SPARTA",
            "state": "NJ",
            "postal_code": "078711773",
            "telephone_number": "973-729-9199",
            "fax_number": "973-729-9260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST OPTOMETRY GROUP, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-28",
        "last_updated": "2013-09-23",
        "status": "A",
        "authorized_official_last_name": "MULLIN",
        "authorized_official_first_name": "BERNARD",
        "authorized_official_title_or_position": "V.P.",
        "authorized_official_telephone_number": "908-832-9211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331420102",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331420106",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331420104",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331420105",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CD9470",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331420103",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sparta, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.