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

Last updated

Nov 27, 2007By the provider in NPPES

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

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 LLCGroup PAC ID 9537597828, 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

  dba Corning Medical Clinic

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

  Corporate Director, Corporate Officer

  CMS ownership
• Greater Regional Medical Center

  dba Lenox Medical Clinic

  • 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

  dba Mount Ayr Community Health Clinic

  • 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eye Care Associates of Co LLC

  dba Optical Matters

  • Optometrist
  • Centennial, CO
  • NPI 1124674049

  IA

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

  dba Creston Vision Clinic

  • Optometrist
  • Creston, IA
  • NPI 1548023518
  NPD

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": [],
    "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 (Southwest Foot and Ankle Center PLC)
• Stacy Lynn Tallman, LMSW
• Theresa R Bensky LLC
• Linda S Thomsen, O.D.
• Trey Matthew Thomsen, OD

• Optometrist in Creston, IA
• Providers in Creston, IA by specialty
• 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.