NPIMap

Organization Active NPI

Eyecare Associates of Southwest Iowa Inc

  • Optometrist
  • Clarinda, IA
National Provider Identifier
1801887484
Registry record updated Aug 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
EYECARE ASSOCIATES OF SOUTHWEST IOWA INC
Practice address
116 E Washington St
Clarinda, IA 51632-1611
Phone
(712) 542-6513
Fax
(712) 542-2274
NPI assigned
Nov 2, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2012

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

Authorized official

Name
Gregory L Samuelson, O.D.NPI 1487645156
Title
Secretary/Treasurer/Owner
Phone
(712) 542-6513

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
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

116 E Washington St
Clarinda, IA 51632-1611

Mailing address

116 E Washington St
Clarinda, IA 51632-1611
Phone (712) 542-6513

Other identifiers 4

IdentifierTypeStateIssuer
0201285MedicaidIA
07311OtherIABCBS
100249544-00MedicaidNE
109192OtherEYEMED

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040311001492 IA Part B Supplier - Clinic/Group Practice 0749179331 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Clarinda, IA; Glenwood, IA; Shenandoah, IA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343952000000",
    "number": "1801887484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 E WASHINGTON ST",
            "city": "CLARINDA",
            "state": "IA",
            "postal_code": "516321611",
            "telephone_number": "712-542-6513",
            "fax_number": "712-542-2274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 E WASHINGTON ST",
            "city": "CLARINDA",
            "state": "IA",
            "postal_code": "516321611",
            "telephone_number": "712-542-6513",
            "fax_number": "712-542-2274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARE ASSOCIATES OF SOUTHWEST IOWA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-02",
        "last_updated": "2012-08-03",
        "status": "A",
        "authorized_official_last_name": "SAMUELSON",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SECRETARY/TREASURER/OWNER",
        "authorized_official_telephone_number": "712-542-6513",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0201285",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "07311",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100249544-00",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "109192",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarinda, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2012; 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.