Ellen Renee Petroczky, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046.009976 Issued in IL

Practice address

363 S Randall Rd
Elgin Family Eye Care
Elgin, IL 60123-5526

Phone

(847) 888-1555

Fax

(847) 888-2508

NPI assigned

Aug 9, 2007

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 IL

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, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Christina J. Levi O D P C.Group PAC ID 9436210762, 63 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 and National Provider Directory roles.

• Christina J. Levi O D P C

  • Optometrist
  • Edwardsville, IL
  • NPI 1477703411
  Medicare reassignment Care Compare group NPD
• Bright Eyes Family Vision, Inc

  • Optometrist
  • Pingree Grove, IL
  • NPI 1649647967
  Medicare reassignment NPD
• Christina J. Levi O D P C

  • Optometrist
  • Edwardsville, IL
  • NPI 1033261904
  NPD (past)
• Susan M Penner

  • Optometrist
  • Elgin, IL
  • NPI 1508088683
  NPD (past)

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

{
    "created_epoch": "1186617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373587200000",
    "number": "1992996383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 LONGFORD DR",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601204688",
            "telephone_number": "815-291-7647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "363 S RANDALL RD",
            "address_2": "ELGIN FAMILY EYE CARE",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601235526",
            "telephone_number": "847-888-1555",
            "fax_number": "847-888-2508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROCZKY",
        "first_name": "ELLEN",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-09",
        "last_updated": "2013-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.009976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Perrin
• Tina Perry, APRN
• Personal Enrichment Therapy LLC
• Emma Pauline Petersen
• Melissa Peterson
• Tyesha Petties
• Emily Jayn Pfeiffer, ANP
• PH Elgin, LLC
• Sherry Pharr, CADC
• Deanna Phelan, DPT

• Optometrist in Elgin, IL
• Providers in Elgin, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.

Verify at the official NPI Registry.