Individual provider Active NPI

Brad Anthony Baggarly, O.D.

  • Optometrist
  • Claremont, CA
National Provider Identifier
1861541617
Registry record updated Apr 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9471-T Issued in CA
Practice address
695 W Foothill Blvd
Claremont, CA 91711-3490
Phone
(909) 625-7861
Fax
(909) 621-0742
NPI assigned
Jan 10, 2007
Last updated
Apr 3, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2012

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 9471-T CA Primary
Corneal and Contact Management Optometrist 152WC0802X 9471-T CA
Pediatric Optometrist 152WP0200X 9471-T CA

Addresses

Primary practice location

695 W Foothill Blvd
Claremont, CA 91711-3490

Mailing address

695 W Foothill Blvd
Claremont, CA 91711-3490
Phone (909) 625-7861

Other identifiers 1

IdentifierTypeStateIssuer
WOP9471AOtherCAMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20090610000587 CA Practitioner - Optometry 8729138961 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brad a Baggarly O D IncGroup PAC ID 6901142744, 3 clinicians

Practice addresses (Care Compare)

695 W Foothill Blvd
Claremont, CA 91711-3490
Phone (909) 625-7861

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9471-TCAMDCorneal and Contact Management Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Brad a Baggarly O D Inc Optometrist CurrentSince Jan 1, 2019 Accepting new patients

Locations

695 W Foothill Blvd
Claremont, CA 91711
Phone (909) 625-7861

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.

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333411200000",
    "number": "1861541617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "695 W FOOTHILL BLVD",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917113490",
            "telephone_number": "909-625-7861",
            "fax_number": "909-621-0742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 W FOOTHILL BLVD",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917113490",
            "telephone_number": "909-625-7861",
            "fax_number": "909-621-0742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGGARLY",
        "first_name": "BRAD",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2012-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9471-T",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "9471-T",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "CA",
            "license": "9471-T",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "WOP9471A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Claremont, CA

Sources for this page

Verify at the official NPI Registry.