NPIMap

Organization Active NPI

Simpson Eye Associates LTD

  • Ophthalmology Physician
  • Crystal Lake, IL
National Provider Identifier
1851348601
Registry record updated Mar 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
SIMPSON EYE ASSOCIATES LTD
Practice address
730 E Terra Cotta Ave
Suite 2B
Crystal Lake, IL 60014-3615
Phone
(815) 455-0212
Fax
(815) 455-4903
NPI assigned
May 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2009

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

Authorized official

Name
Dr. Kenneth Victor Melchionna, D.O.NPI 1982660866
Title
Ceo
Phone
(847) 426-0227

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

730 E Terra Cotta Ave
Suite 2B
Crystal Lake, IL 60014-3615

Mailing address

650 Springhill Ring Rd
Suite #2020
West Dundee, IL 60118-1296
Phone (847) 426-0227

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040820000087 IL Part B Supplier - Clinic/Group Practice 4385618966 Receives reassigned benefits from 11 practitioners
3 other NPIs on this enrollment
Practice locations: Crystal Lake, IL; Hoffman Estates, IL; Huntley, IL; West Dundee, IL

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236211200000",
    "number": "1851348601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 SPRINGHILL RING RD",
            "address_2": "SUITE #2020",
            "city": "WEST DUNDEE",
            "state": "IL",
            "postal_code": "601181296",
            "telephone_number": "847-426-0227",
            "fax_number": "847-426-0299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 E TERRA COTTA AVE",
            "address_2": "SUITE 2B",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600143615",
            "telephone_number": "815-455-0212",
            "fax_number": "815-455-4903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMPSON EYE ASSOCIATES LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2009-03-05",
        "status": "A",
        "authorized_official_last_name": "MELCHIONNA",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "VICTOR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "847-426-0227",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2009; 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.