Individual provider Active NPI

Mark J Hagee, O.D.

  • Optometrist
  • Maineville, OH
National Provider Identifier
1881746261
Registry record updated Jan 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3535 Issued in OH
Practice address
2091 W US Highway 22 and 3
Maineville, OH 45039-9401
Phone
(513) 677-8866
Fax
(513) 677-9113
NPI assigned
Jan 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3535 OH Primary

Addresses

Primary practice location

2091 W US Highway 22 and 3
Maineville, OH 45039-9401

Mailing address

2091 W US Highway 22 and 3
Maineville, OH 45039-9401
Phone (513) 677-8866

Other identifiers 2

IdentifierTypeStateIssuer
311353369OtherOHTAX IDENFIFICATION NUMBER
0827038MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20031211001079 OH Practitioner - Optometry 5193621878 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Interoperability endpoints

  • Direct secure messaging: markhagee.od@direct.revolutionehr.com

Organizations & group practices 1

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": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359331200000",
    "number": "1881746261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2091 W US HIGHWAY 22 AND 3",
            "city": "MAINEVILLE",
            "state": "OH",
            "postal_code": "450399401",
            "telephone_number": "513-677-8866",
            "fax_number": "513-677-9113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2091 W US HIGHWAY 22 AND 3",
            "city": "MAINEVILLE",
            "state": "OH",
            "postal_code": "450399401",
            "telephone_number": "513-677-8866",
            "fax_number": "513-677-9113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGEE",
        "first_name": "MARK",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2013-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "3535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENFIFICATION NUMBER",
            "identifier": "311353369",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0827038",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maineville, OH

Sources for this page

Verify at the official NPI Registry.