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ANTHONY T SWANHOLM OD
NPI 1609228089
Optometrist in Covington, KY

Active since July 08, 2016PECOS EnrolledAccepts Medicare Assignment
90.38/100
CMS Quality Rating
1500 JAMES SIMPSON JR WAY, COVINGTON, KY 41011(859) 655-3111(859) 655-3110 Get Directions Write a Review

NPPES record last updated: April 19, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 19, 2021, Feb 23, 2021, Feb 9, 2021 and 2 more (5 updates tracked since 2018).

About Anthony T Swanholm Od NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANTHONY T SWANHOLM OD (NPI 1609228089) is an individual optometrist in Covington, Kentucky, licensed in Kentucky (2057DT) and active in the NPI registry since July 2016. He is enrolled in Medicare PECOS, maintains a secondary practice location in Cincinnati, and is a graduate of Pacific University - College Of Optometry (2016).

NPPES Registry Identity

NPI1609228089
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameANTHONY T SWANHOLMCredential: OD
Location Address1500 JAMES SIMPSON JR WAYCovington, KY 41011-0801
Mailing AddressPo Box 635283Cincinnati, OH 45263-5286 · (859) 344-5555 · Fax (859) 344-5554
Phone(859) 655-3111
Fax(859) 655-3110
Sole ProprietorNo
Medical School CMSPacific University - College Of OptometryGraduated 2016
Enumeration DateJuly 8, 2016
Last NPPES UpdateApril 19, 20215 updates tracked since enumeration
NPPES CertifiedApril 19, 2021
✔ NPI 1609228089 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
Licenses✔ Licensed in KY · 2057DT✔ Licensed in OH · OPT.006714
Definition
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.
1500 JAMES SIMPSON JR WAY, Covington, KY 41011
Open in Google Maps ↗

Secondary Practice Location 1

Location 1105 W 4th StCincinnati, OH 45202-2712 · Phone (513) 621-2445 · Fax (513) 621-2513

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Home State Health, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Anthony T Swanholm Od is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1951695451
PECOS Enrollment IDI20170719000500
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
173 services149 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
115 services115 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
69 services61 patients
Imaging of retina 92134
Imaging of the retina is a non-invasive procedure that captures detailed images of your eye's interior. This helps detect conditions like macular degeneration or retinal detachment. It's painless and takes only a few minutes.
63 services57 patients
Imaging of optic nerve 92133
Imaging of the optic nerve is a non-invasive procedure that captures detailed pictures of your optic nerve. It helps doctors assess eye health, particularly for conditions like glaucoma. It's painless, quick, and uses safe technology like MRI or OCT (Optical Coherence Tomography).
50 services36 patients
Exam of visual field with extended testing 92083
An extended visual field exam is a detailed test to evaluate your peripheral (side) vision. It helps to detect any potential blind spots which may not be noticeable in daily life. These could be caused by eye diseases like glaucoma, or neurological conditions.
33 services28 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 41011 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$122.77 typical visit price
range $52.76 – $162.27
Typical copayment $30.69 (range $13.19 – $40.56)
Most-billed visit code 99204
Established Patient
$66.24 typical visit price
range $16.53 – $131.99
Typical copayment $16.56 (range $4.13 – $32.99)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

90.38/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality80.76
Promoting Interoperability100
Improvement Activities40

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KENNETRA BRADSHAW RD
Dietitian, Registered
1500 JAMES SIMPSON JR WAY
COVINGTON, KY 41011
Kenton County (859) 655-8910
DR. EUGENE JAMES BURCHELL JR. M.D.
Obstetrics & Gynecology
1500 JAMES SIMPSON JR WAY, WOULD CARE DEPT.
COVINGTON, KY 41011
Kenton County (859) 655-1100
WAEL E EID MD
Internal Medicine (Endocrinology, Diabetes & Metabolism)
1500 JAMES SIMPSON JR WAY, SUITE 301
COVINGTON, KY 41011
Kenton County (859) 655-8910
MR. ERIC R WOOD PA-C
Physician Assistant
1500 JAMES SIMPSON JR WAY
COVINGTON, KY 41011
Kenton County (859) 655-1100
MRS. BRIANA L. VITUCCI RD
Dietitian, Registered
1500 JAMES SIMPSON JR WAY
COVINGTON, KY 41011
Kenton County (859) 655-8910
RAE ELIZAGARAY RD
Dietitian, Registered
1500 JAMES SIMPSON JR WAY
COVINGTON, KY 41011
Kenton County (859) 655-8910
DR. NED MEHLMAN M.D.
Internal Medicine (Cardiovascular Disease)
1500 JAMES SIMPSON JR WAY
COVINGTON, KY 41011
Kenton County (859) 655-9500
IRINA KORABLEVA MD
Internal Medicine (Endocrinology, Diabetes & Metabolism)
1500 JAMES SIMPSON JR WAY
COVINGTON, KY 41011
Kenton County (859) 655-8910

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Anthony Swanholm's NPI number?

The NPI number for Anthony Swanholm is 1609228089. It was assigned to this individual provider in the NPPES registry on July 8, 2016.

Where is Anthony Swanholm located?

Anthony Swanholm practices at 1500 James Simpson Jr Way, Covington, KY 41011. The listed phone number is (859) 655-3111.

What is Anthony Swanholm's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Anthony Swanholm enrolled in Medicare?

Yes. Anthony Swanholm is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Anthony Swanholm accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Home State Health, Ambetter of Tennessee and CareSource list Anthony Swanholm as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Anthony Swanholm was last updated on April 19, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.