Individual provider Active NPI

Elli J Kollbaum, O.D.

  • Optometrist
  • Bloomington, IN
National Provider Identifier
1851360648
Registry record updated Jan 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18002935 Issued in IN
Practice address
744 E 3Rd St
Bloomington, IN 47405-3603
Phone
(812) 855-8436
Fax
(812) 855-1683
NPI assigned
Mar 15, 2006
Last updated
Jan 12, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18002935 IN Primary

Addresses

Primary practice location

744 E 3Rd St
Bloomington, IN 47405-3603

Mailing address

744 E 3Rd St
Bloomington, IN 47405-3603
Phone (812) 855-8436

Other identifiers 1

IdentifierTypeStateIssuer
200284870MedicaidIN

Other names 1

  • Dr. Elli J Reichelt Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Direct@IndianaUnivSchoolOfOptomBloomingtonIN.CompulinkDirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20040803000801 IN Practitioner - Optometry 7113998220 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Indiana UniversityGroup PAC ID 6002806957, 64 clinicians

Practice addresses (Care Compare)

744 E 3Rd St
Bloomington, IN 47405-3603
Phone (812) 855-8436

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Indiana University Optometrist CurrentSince Jul 1, 2000 Accepting new patients
Indiana University Optometrist Current Accepting new patients

Locations

744 E 3rd St
Bloomington, IN 47405
Phone (812) 855-8436

800 E Atwater Ave
Bloomington, IN 47405
Phone (812) 855-4447

800 E Atwater Ave
Rm 264
Bloomington, IN 47405

1160 W Michigan St
Ste 100
Indianapolis, IN 46202
Phone (317) 278-1470

Interoperability endpoints

  • Direct secure messaging: direct@indianaunivschoolofoptombloomingtonin.compulinkdirect.com

Organizations & group practices 2

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768176000000",
    "number": "1851360648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "744 E 3RD ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474053603",
            "telephone_number": "812-855-8436",
            "fax_number": "812-855-1683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 E 3RD ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474053603",
            "telephone_number": "812-855-8436",
            "fax_number": "812-855-1683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLBAUM",
        "first_name": "ELLI",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-15",
        "last_updated": "2026-01-12",
        "certification_date": "2026-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002935",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200284870",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Direct@IndianaUnivSchoolOfOptomBloomingtonIN.CompulinkDirect.com",
            "affiliation": "N",
            "endpointDescription": "IUSO direct email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "text",
            "address_1": "744 E 3rd St",
            "city": "Bloomington",
            "state": "IN",
            "country_code": "US",
            "postal_code": "474053603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ELLI",
            "last_name": "REICHELT",
            "middle_name": "J",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bloomington, IN

Sources for this page

Verify at the official NPI Registry.