Kelly G Ross OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

2485 Issued in AR

Legal business name

KELLY G ROSS OD PA

Doing business as

ross eye care center

Practice address

1014 W Main St
Walnut Ridge, AR 72476-1004

Phone

(870) 886-2632

Fax

(870) 886-1514

NPI assigned

Dec 28, 2006

Last updated

Mar 5, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kelly Ross, O.D.NPI 1073549200

Title

Owner

Phone

(870) 886-2632

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• ross eye care center Doing business as

Medicare fee-for-service enrollment

Enrolled in AR2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelly G Ross, O.D.

  • Optometrist
  • Walnut Ridge, AR
  • NPI 1073549200
  Medicare reassignment Care Compare group Authorized official
• Jonathan Blake Ross, OD

  • Optometrist
  • Jonesboro, AR
  • NPI 1881638328
  Medicare reassignment Care Compare group NPD
• John T McHaney, O.D.

  • Optometrist
  • Walnut Ridge, AR
  • NPI 1295822708
  NPD (past)

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236211200000",
    "number": "1982760955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 W MAIN ST",
            "address_2": "P.O. BOX 349",
            "city": "WALNUT RIDGE",
            "state": "AR",
            "postal_code": "724761004",
            "telephone_number": "870-886-2632",
            "fax_number": "870-886-1514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 W MAIN ST",
            "city": "WALNUT RIDGE",
            "state": "AR",
            "postal_code": "724761004",
            "telephone_number": "870-886-2632",
            "fax_number": "870-886-1514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY G ROSS OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2009-03-05",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-886-2632",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5F267",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167096722",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ross eye care center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cassandra Lou Hunter, M.D.
• Blake Jamison
• Kimberly Kaye Johnson, QBHP
• Sadie Elizabeth Johnson
• Cody Jones, ATC
• Danny Handford Kent, D.C.
• Kids and Company, LLC
• Kidspot Learning Center
• Kidspot Walnut Ridge
• Kidspot Walnut Ridge

• Optometrist in Walnut Ridge, AR
• Providers in Walnut Ridge, AR by specialty
• Optometrist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.