Active NPI
Timothy James Hennie, O.D.
- Optometrist
- Salisbury, NC
National Provider Identifier
1972561306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1071
- Practice address
- 1910 Jake Alexander Blvd W
Suite 101
Salisbury, NC 28147-1163 - Phone
- (704) 633-2581
- Fax
- (704) 633-2592
- NPI assigned
- May 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1071 | NC | Primary |
Addresses
Primary practice location
1910 Jake Alexander Blvd W
Suite 101
Salisbury, NC 28147-1163
Mailing address
1910 Jake Alexander Blvd W
Suite 101
Salisbury, NC 28147-1162
Phone (704) 633-2581
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 561430045 | Other | NC | SUPERIOR VISION PLAN |
| 2200141 | Other | NC | UNITED HEALTHCARE |
| 51812 | Other | NC | DAVIS VISION PLAN |
| 8909387 | Medicaid | NC | |
| 110899 | Other | NC | EYEMED |
| 09387 | Other | NC | BLUE CROSS BLUE SHIELD |
| 10799 | Other | NC | OPTICARE |
| 48550 | Other | NC | SPECTERA |
| NC01071 | Other | NC | VISION BENEFITS OF AMERIC |
| 561430045 | Other | NC | PRIMARY PHYSICIAN CARE |
| 561430045 | Other | NC | PARTNERS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040707001187 | NC | Practitioner - Optometry | 1951389949 | Practice locations: Salisbury, NC |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Ohio State University - College of Optometry, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1910 W Jake Alexander Blvd
Suite 101
Salisbury, NC 28147-1163
Phone (704) 663-2581
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 31 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1071 | NC | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Myeyedr Optometry of North Carolina PLLC | Optometrist | Past | 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.
-
- Optometrist
- Salisbury, NC
- NPI 1760094601
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361923200000",
"number": "1972561306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1910 JAKE ALEXANDER BLVD W",
"address_2": "SUITE 101",
"city": "SALISBURY",
"state": "NC",
"postal_code": "281471162",
"telephone_number": "704-633-2581",
"fax_number": "704-633-2592"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1910 JAKE ALEXANDER BLVD W",
"address_2": "SUITE 101",
"city": "SALISBURY",
"state": "NC",
"postal_code": "281471163",
"telephone_number": "704-633-2581",
"fax_number": "704-633-2592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENNIE",
"first_name": "TIMOTHY",
"middle_name": "JAMES",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-03",
"last_updated": "2013-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NC",
"license": "1071",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SUPERIOR VISION PLAN",
"identifier": "561430045",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "2200141",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DAVIS VISION PLAN",
"identifier": "51812",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8909387",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EYEMED",
"identifier": "110899",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "09387",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTICARE",
"identifier": "10799",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPECTERA",
"identifier": "48550",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VISION BENEFITS OF AMERIC",
"identifier": "NC01071",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIMARY PHYSICIAN CARE",
"identifier": "561430045",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARTNERS",
"identifier": "561430045",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salisbury, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2013; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.