Kenneth D Stults, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

02061 Issued in IA

Practice address

1610 W Townline St
Ste 115
Creston, IA 50801-1064

Phone

(641) 782-7619

Fax

(641) 782-6549

NPI assigned

Jun 9, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in IA

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

Specialty

Optometry

Education

Indiana University - School of Optometry, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Care Associates of Co LLC 63 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Greater Regional Medical Center

  • Rural Health Clinic/Center
  • Corning, IA
  • NPI 1275048977

  Corporate Director, Corporate Officer

  CMS ownership
• Greater Regional Medical Center

  • Rural Health Clinic/Center
  • Lenox, IA
  • NPI 1346353323

  Corporate Director, Corporate Officer

  CMS ownership
• Greater Regional Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Creston, IA
  • NPI 1639180748

  Corporate Director, Corporate Officer

  CMS ownership
• Greater Regional Medical Center

  • Rural Health Clinic/Center
  • Mount Ayr, IA
  • NPI 1639684335

  Corporate Director, Corporate Officer

  CMS ownership
• Greater Regional Medical Center

  • Critical Access Hospital
  • Creston, IA
  • NPI 1902805062

  Corporate Director, Corporate Officer

  CMS ownership

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.

• Eye Care Associates of Co LLC

  • Optometrist
  • Centennial, CO
  • NPI 1124674049

  IA, Optometrist

  Medicare reassignment Care Compare group NPD
• Eye Care Associates of Co LLC

  • Optometrist
  • Creston, IA
  • NPI 1548023518
  Care Compare group NPD
• Eye Care Associates of Co LLC

  • Optometrist
  • Fort Dodge, IA
  • NPI 1104689165
  Care Compare group
• Eye Care Associates of Co, LLC

  • Optometrist
  • Atlantic, IA
  • NPI 1215790290
  Care Compare group
• Eye Care Associates of Co, LLC

  • Optometrist
  • Creston, IA
  • NPI 1770346751
  Care Compare group
• Eye Care Associates of Co, LLC

  • Optometrist
  • Grinnell, IA
  • NPI 1801659792
  Care Compare group
• Eye Care Associates of Co, LLC

  • Optometrist
  • Red Oak, IA
  • NPI 1881457760
  Care Compare group

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196121600000",
    "number": "1982608865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 427",
            "city": "CRESTON",
            "state": "IA",
            "postal_code": "508010427",
            "telephone_number": "641-782-7619",
            "fax_number": "641-782-6549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 W TOWNLINE ST",
            "address_2": "STE 115",
            "city": "CRESTON",
            "state": "IA",
            "postal_code": "508011064",
            "telephone_number": "641-782-7619",
            "fax_number": "641-782-6549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STULTS",
        "first_name": "KENNETH",
        "middle_name": "D",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2007-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "02061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "51981",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OD LICENSE",
            "identifier": "1520261",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0128975",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA LICENSE",
            "identifier": "02061",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Guerline Sinsmyr, MD
• Darla K Sobotka, PA-C
• Southern Iowa Resources for Families, Inc
• Southern Iowa Trolley
• Cheryl L Standing, MD
• Swfac PLC
• Stacy Lynn Tallman, LMSW
• Kylie Tate
• Theresa R Bensky LLC
• Linda S Thomsen, O.D.

• All providers in Creston, IA
• Optometrist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.

Verify at the official NPI Registry.