Individual provider Active NPI

Fiona Yuan, OD

  • Optometrist
  • Jbsa-Fort Sam Houston, TX
National Provider Identifier
1972155620
Registry record updated Oct 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ODP-100479 Issued in ID
Practice address
San Antonio Military Medical Center, McHe-Dzo
3551 Roger Brooke Drive
Jbsa-Fort Sam Houston, TX 78234-4504
Phone
(210) 295-4335
NPI assigned
Jul 12, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 31, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X ODP-100479 ID Primary

Addresses

Primary practice location

San Antonio Military Medical Center, McHe-Dzo
3551 Roger Brooke Drive
Jbsa-Fort Sam Houston, TX 78234-4504

Mailing address

San Antonio Military Medical Center, McHe-Dzo
3551 Roger Brooke Drive
Jbsa-Fort Sam Houston, TX 78234-4504

Other identifiers 1

IdentifierTypeStateIssuer
ODP-100479OtherIDSTATE LICENSURE

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20240130003112 CA Practitioner - Optometry 8921451576 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4733 W Sunset Blvd
Los Angeles, CA 90027-6021
Phone (213) 667-4784

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ODP-100479IDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Marshall B. Ketchum University/University Eye Center at Los Angeles Optometrist CurrentSince May 1, 2024 Accepting new patients
Marshall B. Ketchum University Optometrist Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 13, 2023 Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 13, 2023 Accepting new patients
Marshall B. Ketchum University CurrentSince May 1, 2024 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

4733 W Sunset Blvd
Los Angeles, CA 90027
Phone (213) 667-4784

3916 S Broadway
Los Angeles, CA 90037
Phone (323) 234-9137

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 6

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": "1562889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1972155620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-DZO",
            "address_2": "3551 ROGER BROOKE DRIVE",
            "city": "JBSA-FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-DZO",
            "address_2": "3551 ROGER BROOKE DRIVE",
            "city": "JBSA-FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "210-295-4335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YUAN",
        "first_name": "FIONA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-12",
        "last_updated": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSURE",
            "identifier": "ODP-100479",
            "state": "ID"
        }
    ],
    "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": "4733 W Sunset Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900276021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jbsa-Fort Sam Houston, TX

Sources for this page

Verify at the official NPI Registry.