Kaitlyn Renae Gibson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

18004243A Issued in IN

Practice address

13115 Wicker Ave Ste E
Cedar Lake, IN 46303-7400

Phone

(219) 374-7800

Fax

(219) 374-5196

NPI assigned

Aug 31, 2020

Last updated

Aug 31, 2020By the provider in NPPES

Sex

Female

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 IN

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

Illinois College of Optometry at Chicago, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Region Eye Care LLCGroup PAC ID 0648521203, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Region Eye Care LLC

  dba South Shore Eye Care

  • Optometrist
  • Munster, IN
  • NPI 1043717945
  Medicare reassignment Care Compare group
• Illiana Eyecare Inc

  • Optometrist
  • Cedar Lake, IN
  • NPI 1215040142
  Medicare reassignment NPD

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

{
    "created_epoch": "1598832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1992319719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13115 WICKER AVE STE E",
            "city": "CEDAR LAKE",
            "state": "IN",
            "postal_code": "463037400",
            "telephone_number": "219-374-7800",
            "fax_number": "219-374-5196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13115 WICKER AVE STE E",
            "city": "CEDAR LAKE",
            "state": "IN",
            "postal_code": "463037400",
            "telephone_number": "219-374-7800",
            "fax_number": "219-374-5196"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1001 Main St Ste 1",
            "address_purpose": "LOCATION",
            "city": "Dyer",
            "state": "IN",
            "postal_code": "463111200",
            "country_code": "US",
            "telephone_number": "219-322-7800",
            "fax_number": "219-322-5556",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "KAITLYN",
        "middle_name": "RENAE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-31",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18004243A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scarlett Rachel Fox, MS,CCC-SLP
• Alesha Gall, FNP-C
• Michelle Gehring
• Gerstenkorn Family Chiropractic, P.C.
• Scott Alan Gerstenkorn, D.C.
• Halie Gonlag, LSW
• Christine J Gudas, DDS
• Katherine R Haded, MHS
• Hanover Community School Corporation
• Terry Harman, LCSW

• Optometrist in Cedar Lake, IN
• Providers in Cedar Lake, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; 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.

Verify at the official NPI Registry.