Individual provider Active NPI

Mary Ann Celentano, O.D.

  • Optometrist
  • Springfield, MA
National Provider Identifier
1821163312
Registry record updated Jan 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4506 Issued in MA
Practice address
305 Bicentennial Highway
Springfield, MA 01118
Phone
(413) 733-4101
Fax
(413) 796-6821
NPI assigned
Nov 21, 2006
Last updated
Jan 15, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4506 MA Primary

Addresses

Primary practice location

305 Bicentennial Highway
Springfield, MA 01118

Mailing address

305 Bicentennial Highway
Springfield, MA 01118
Phone (413) 733-4101

Other identifiers 1

IdentifierTypeStateIssuer
110025183/AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20050713000707 MA Practitioner - Optometry 6709822885

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4506MAMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Vision Showcase Past Accepting new patients
Riverbend Medical Group, Inc Past Accepting new patients
DD&G Holdings P.C. Past Accepting new patients

Organizations & group practices 3

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": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452816000000",
    "number": "1821163312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 BICENTENNIAL HIGHWAY",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "01118",
            "telephone_number": "413-733-4101",
            "fax_number": "413-796-6821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 BICENTENNIAL HIGHWAY",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "01118",
            "telephone_number": "413-733-4101",
            "fax_number": "413-796-6821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CELENTANO",
        "first_name": "MARY",
        "middle_name": "ANN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2016-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110025183/A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MA

Sources for this page

Verify at the official NPI Registry.