Active NPI
Gena R Kidd, M.D.
- Ophthalmology Physician
- Lafayette, IN
National Provider Identifier
1922072339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 01054602A
- Practice address
- 1400 Teal Rd
Suite 8
Lafayette, IN 47905-2463 - Phone
- (765) 477-2020
- Fax
- (765) 477-8200
- NPI assigned
- Feb 14, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cornea and External Diseases Specialist Physician | 207WX0120X | 01054602A | IN | |
| Ophthalmology Physician | 207W00000X | 01054602A | IN | Primary |
Addresses
Primary practice location
1400 Teal Rd
Suite 8
Lafayette, IN 47905-2463
Mailing address
1400 Teal Rd
Suite 8
Lafayette, IN 47905-2463
Phone (765) 477-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200349180 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
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.
-
- Ophthalmology Physician
- Lafayette, IN
- NPI 1376517573
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525219200000",
"number": "1922072339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 TEAL RD",
"address_2": "SUITE 8",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479052463",
"telephone_number": "765-477-2020",
"fax_number": "765-477-8200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 TEAL RD",
"address_2": "SUITE 8",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479052463",
"telephone_number": "765-477-2020",
"fax_number": "765-477-8200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIDD",
"first_name": "GENA",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-14",
"last_updated": "2018-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "207WX0120X",
"taxonomy_group": "",
"desc": "Ophthalmology, Cornea and External Diseases Specialist",
"state": "IN",
"license": "01054602A",
"primary": false
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "IN",
"license": "01054602A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200349180",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2018; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.