Bobby Sinsongserm

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT-002365 Issued in AZ

Practice address

483 W Seed Farm Rd
Sacaton, AZ 85147-5000

Phone

(520) 562-3321

NPI assigned

Jun 15, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NV, CA2 enrollments

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 2

Specialty

Optometry

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Riverside, CA
  • NPI 1316979834
  Medicare reassignment Care Compare group NPD
• Pritchett Eye Care PC

  • Optometrist
  • Sparks, NV
  • NPI 1962717603
  Medicare reassignment
• Pritchett Eye Care PC

  • Optometrist
  • Sparks, NV
  • NPI 1679889372
  NPD
• Pritchett Eye Care PC

  • Optometrist
  • Pahrump, NV
  • NPI 1730664327
  NPD
• Pritchett Eye Care PC

  • Optometrist
  • Fernley, NV
  • NPI 1952962375
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD

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

{
    "created_epoch": "1560556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638835200000",
    "number": "1902466659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13724 EL ESPEJO RD",
            "city": "LA MIRADA",
            "state": "CA",
            "postal_code": "906383718",
            "telephone_number": "562-447-6307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "483 W SEED FARM RD",
            "city": "SACATON",
            "state": "AZ",
            "postal_code": "851475000",
            "telephone_number": "520-562-3321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13724 El Espejo Rd",
            "address_purpose": "LOCATION",
            "city": "LA Mirada",
            "state": "CA",
            "postal_code": "906383718",
            "country_code": "US",
            "telephone_number": "562-447-6307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SINSONGSERM",
        "first_name": "BOBBY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-15",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "OPT-002365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10800 Magnolia Ave",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925053043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emilie Shin
• Joe Shin, LMSW
• Kelsey Siever
• Rosalinda Sigarroba
• Shawn Sindlinger, LCSW
• Carly N. Sirota, FNP
• Misty Dawn Skoda, RN
• Eric Eugene Sluiter, DPM
• Della M Sockyma, LMSW, LISAC
• Aaron Todd Solen, O.D.

• Optometrist in Sacaton, AZ
• Providers in Sacaton, AZ by specialty
• Optometrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.