NPIMap

Organization Active NPI

Central Illinois Optometric Associates LTD

  • Optometrist
  • Carlinville, IL
National Provider Identifier
1851417513
Registry record updated Apr 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046008125 Issued in IL
Legal business name
CENTRAL ILLINOIS OPTOMETRIC ASSOCIATES LTD
Practice address
615 N Broad St
Carlinville, IL 62626-1020
Phone
(217) 854-3173
NPI assigned
Mar 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2011

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

Authorized official

Name
Dr. Keith Hedrick
Title
Ceo
Phone
(217) 854-3173

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 046008125 IL Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 046006408 IL

Addresses

Primary practice location

615 N Broad St
Carlinville, IL 62626-1020

Mailing address

615 N Broad St
Carlinville, IL 62626-1020
Phone (217) 854-3173

Other identifiers 5

IdentifierTypeStateIssuer
046006408MedicaidIL
410042496OtherILRUBRICH RAILROAD NUMBER
410042452OtherILHEDRICK RAILROAD NUMBER
0001115000OtherILBC BS GROUP NUMBER
046008125MedicaidIL

Other names 1

  • Advanced Eyecare of Carlinville Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930051307 IL DME Supplier - Physician - Optometrist 7618886318 Practice locations: Carlinville, IL
O20110222001096 IL Part B Supplier - Clinic/Group Practice 7618886318 Receives reassigned benefits from 6 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carlinville, IL; Lincoln, IL; Taylorville, IL; Virden, IL

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Advanced Eyecare of Carlinville615 N Broad St, Carlinville, IL 62626-1020(217) 857-3173 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Debra S Smothers3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

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": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303084800000",
    "number": "1851417513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 N BROAD ST",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626261020",
            "telephone_number": "217-854-3173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N BROAD ST",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626261020",
            "telephone_number": "217-854-3173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL ILLINOIS OPTOMETRIC ASSOCIATES LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2011-04-18",
        "status": "A",
        "authorized_official_last_name": "HEDRICK",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-854-3173",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046008125",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046006408",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046006408",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RUBRICH RAILROAD NUMBER",
            "identifier": "410042496",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEDRICK RAILROAD NUMBER",
            "identifier": "410042452",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS GROUP NUMBER",
            "identifier": "0001115000",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046008125",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Eyecare of Carlinville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carlinville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.