SIGNATURE MEDICAL GROUP
NPI 1316121775
Optometrist in Brockton, MA
NPI Status: Active since December 20, 2007
Contact Information
110 LIBERTY ST
BROCKTON, MA
ZIP 02301
Phone: (508) 894-0400
Fax: (508) 565-0157
- Organization
- Optometrist
- Accepts Insurance
- CLIA Number: 22D2015058
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 02-16-2026
About SIGNATURE MEDICAL GROUP
This page provides the complete NPI Profile along with additional information for Signature Medical Group, a provider established in Brockton, Massachusetts operating as a Optometrist. The healthcare provider is registered in the NPI registry with number 1316121775 assigned on December 2007. The practitioner's primary taxonomy code is 152W00000X with license number 3009 (MA). The provider is registered as an organization and their NPI record was last updated 14 years ago. Signature Medical Group operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The provider's is doing business as Signature Medical Group. The authorized official of this NPI record is Mr. Kim Hollon (Ceo)
- NPI
- 1316121775
- Provider Legal Name
- BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES, INC OPTOMETRY DIVISION
- Other Organization Name
- SIGNATURE MEDICAL GROUP
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 110 LIBERTY ST BROCKTON, MA 02301
- Location Phone
- (508) 894-0400
- Location Fax
- (508) 565-0157
- Mailing Address
- 110 LIBERTY ST BROCKTON, MA 02301
- Mailing Phone
- (508) 894-0400
- Mailing Fax
- (508) 565-0157
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 12-20-2007
- Last Update Date
- 05-23-2012
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Optometrist
- Taxonomy Code
- 152W00000X
- Type
- Eye and Vision Services Providers
- License No.
- 3009
- License State
- MA
- Taxonomy Description
- Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Max 70/50 $6700 with 2 $0 PCP Virtual Visits HSA Eligible - PPO
- Blue Max 80/60 $1500 with 2 $0 PCP Virtual Visits - PPO
- Blue Max Copay (PCP) 50/50 $3300 with 2 $0 PCP Virtual Visits - PPO
- Blue Max Copay (PCP) 50/50 $7500 Standardized HSA Eligible - PPO
- Blue Max Copay (PCP) 60/40 $6000 Standardized - PPO
- Blue Max Copay (PCP) 75/55 $2000 Standardized - PPO
- Blue Saver 60/40 $6100 - PPO
- Blue Saver 90/70 $3400 - PPO
- BlueSelect Bronze Basic - PPO
- BlueSelect Bronze Core - PPO
- BlueSelect Expanded Bronze Standard without Kid's Dental - PPO
- BlueSelect Gold Core - PPO
- BlueSelect Gold HealthPlus - PPO
- BlueSelect Gold Standard without Kid's Dental - PPO
- BlueSelect Silver Classic - PPO
- BlueSelect Silver Classic without Kid's Dental - PPO
- BlueSelect Silver HealthPlus - PPO
- BlueSelect Silver HealthPlus without Kid's Dental - PPO
- BlueSelect Silver Standard without Kid's Dental - PPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 110022141E | MEDICAID (05) | MA | |
| M20452 | MEDICARE PIN (08) | MA |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 22D2015058
- Facility Type
- Physician Office
- Certificate Effective Date
- February 17, 2024
- Certificate Expiration Date
- February 16, 2026
- Laboratory Director
- DR. VIJAYA T. DANIEL
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Signature Medical Group after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1316121775, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 55. The final step is to find the difference between that total and the next multiple of ten (60 - 55 = 5).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 55 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
BROCKTON, MA 02301
BROCKTON, MA 02301
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1316121775, enumerated as an "organization" on December 20, 2007.
The provider is located at 110 LIBERTY ST BROCKTON, MA 02301 and the phone number is (508) 894-0400.
Optometrist with taxonomy code 152W00000X.
The provider might be accepting Accepts: Blue Cross and Blue Shield of Louisiana, Blue. Please consult your insurance carrier or call the provider to verify.
