NPIMap

Organization Active NPI

Childrens Eye Care PC

  • Ophthalmology Physician
  • Dearborn, MI
National Provider Identifier
1922069806
Registry record updated Apr 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
CHILDRENS EYE CARE PC
Practice address
22731 Newman St Ste 245
Dearborn, MI 48124-2023
Phone
(313) 561-1777
Fax
(313) 561-8044
NPI assigned
Mar 30, 2006
Last updated
Apr 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2020

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

Authorized official

Name
John Roarty, MDNPI 1114980893
Title
President
Phone
(313) 561-1777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary
Pediatric Ophthalmology and Strabismus Specialist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207WX0110X

Addresses

Primary practice location

22731 Newman St Ste 245
Dearborn, MI 48124-2023

Mailing address

6689 Orchard Lake Rd # 297
West Bloomfield, MI 48322-3404
Phone (248) 254-8140

Other practice location 1

2355 Monroe Boulevard
Dearborn, MI 48124
Phone (313) 561-4466

Other identifiers 1

IdentifierTypeStateIssuer
1534388MedicaidMI

Other names 1

  • Pediatric Ophthalmology Associate Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070531000554 MI Part B Supplier - Clinic/Group Practice 0244338127 Receives reassigned benefits from 9 practitioners
3 other NPIs on this enrollment
Practice locations: Dearborn, MI; West Bloomfield, MI; Detroit, MI; Clinton Township, MI

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Childrens Eye Care PC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1143676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587340800000",
    "number": "1922069806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6689 ORCHARD LAKE RD # 297",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483223404",
            "telephone_number": "248-254-8140",
            "fax_number": "248-254-8150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22731 NEWMAN ST STE 245",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242023",
            "telephone_number": "313-561-1777",
            "fax_number": "313-561-8044"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2355 Monroe Boulevard",
            "address_purpose": "LOCATION",
            "city": "Dearborn",
            "state": "MI",
            "postal_code": "48124",
            "country_code": "US",
            "telephone_number": "313-561-4466",
            "fax_number": "313-561-8044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHILDRENS EYE CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-30",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A",
        "authorized_official_last_name": "ROARTY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-561-1777",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207WX0110X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1534388",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Ophthalmology Associate",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Pediatric Ophthalmology Associate",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.