Active NPI
Robert S. Proffitt, M.D.
- Ophthalmology Physician
- Grand Island, NE
National Provider Identifier
1972506871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 12878
- Practice address
- 711 N Custer Ave
Grand Island, NE 68803-4311 - Phone
- (308) 382-1781
- Fax
- (308) 382-1474
- NPI assigned
- May 24, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 12878 | NE | Primary |
Addresses
Primary practice location
711 N Custer Ave
Grand Island, NE 68803-4311
Mailing address
711 N Custer Ave
Grand Island, NE 68803-4311
Phone (308) 382-1781
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12878 | Other | NE | LICENSE |
| 10-025813800 | Medicaid | NE | |
| 180038420 | Other | NE | RAILROAD MEDICARE PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physicians Eyewear, L.L.C. | Current | Accepting new patients |
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.
-
- Eyewear Supplier
- Grand Island, NE
- NPI 1790788677
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1273622400000",
"number": "1972506871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "711 N CUSTER AVE",
"city": "GRAND ISLAND",
"state": "NE",
"postal_code": "688034311",
"telephone_number": "308-382-1781",
"fax_number": "308-382-1474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "711 N CUSTER AVE",
"city": "GRAND ISLAND",
"state": "NE",
"postal_code": "688034311",
"telephone_number": "308-382-1781",
"fax_number": "308-382-1474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROFFITT",
"first_name": "ROBERT",
"middle_name": "S.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-24",
"last_updated": "2010-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NE",
"license": "12878",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "12878",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10-025813800",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE PROVIDER NUMBER",
"identifier": "180038420",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Island, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.