Individual provider Active NPI

Grant Elliot Schaneman, O.D.

  • Corneal and Contact Management Optometrist
  • Johnstown, CO
National Provider Identifier
1922058833
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Corneal and Contact Management OptometristTaxonomy code 152WC0802X
License
2410 Issued in CO
Practice address
257 Johnstown Center Dr
Suite 107
Johnstown, CO 80534-9073
Phone
(970) 587-0827
NPI assigned
May 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management Optometrist 152WC0802X 2410 CO Primary

Addresses

Primary practice location

257 Johnstown Center Dr
Suite 107
Johnstown, CO 80534-9073

Mailing address

251 Hawthorne Ave
Johnstown, CO 80534-9184
Phone (970) 587-0827

Other identifiers 2

IdentifierTypeStateIssuer
2204624OtherCOEVERCARE
74130293MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20060808000556 CO Practitioner - Optometry 1052314275 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

16 N Parish Ave
Johnstown, CO 80534-9097
Phone (970) 587-0827

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1207NEMDPsychologist
2410COMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Precision Family Eyecare PC Corneal and Contact Management CurrentSince May 14, 2006 Accepting new patients

Locations

16 N Parish Ave
Johnstown, CO 80534
Phone (970) 587-0827

257 Johnstown Center Dr
Unit 107
Johnstown, CO 80534
Phone (816) 806-1664

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213142400000",
    "number": "1922058833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 HAWTHORNE AVE",
            "city": "JOHNSTOWN",
            "state": "CO",
            "postal_code": "805349184",
            "telephone_number": "970-587-0827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "257 JOHNSTOWN CENTER DR",
            "address_2": "SUITE 107",
            "city": "JOHNSTOWN",
            "state": "CO",
            "postal_code": "805349073",
            "telephone_number": "970-587-0827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHANEMAN",
        "first_name": "GRANT",
        "middle_name": "ELLIOT",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2008-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CO",
            "license": "2410",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "2204624",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74130293",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnstown, CO

Sources for this page

Verify at the official NPI Registry.