DR. JOHN E PRATT O.D.
NPI 1730289315
Optometrist in Mount Vernon, OH

NPI Status: Active since September 24, 2006

Contact Information

1575 COSHOCTON AVE
MOUNT VERNON, OH
ZIP 43050
Phone: (740) 392-3305
Fax: (740) 392-3410

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Medicare Participation & PECOS Status
Physician Visit Costs
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Male
Optometrist
Accepts Insurance
PECOS Enrolled
Opted-Out Medicare

About JOHN PRATT

This page provides the complete NPI Profile along with additional information for John Pratt, a provider established in Mount Vernon, Ohio with a medical specialization in Optometrist. The healthcare provider is registered in the NPI registry with number 1730289315 assigned on September 2006. The practitioner's primary taxonomy code is 152W00000X with license number 3819T962 (OH). The provider is registered as an individual and his NPI record was last updated 9 years ago.

NPI: 1730289315
Provider Name: DR. JOHN E PRATT O.D.
Gender: Male
Entity Type: Individual
Location Address: 1575 COSHOCTON AVE MOUNT VERNON, OH 43050
Location Phone: (740) 392-3305
Location Fax: (740) 392-3410
Mailing Address: 5661 INNISBROOK CT WESTERVILLE, OH 43082
Mailing Phone: (740) 392-3305
Is Sole Proprietor?: Yes
Enumeration Date: 09-24-2006
Last Update Date: 04-25-2016
Code Navigator

The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. John Pratt opted out of Medicare effective on 06-23-2016 until 06-23-2026. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare but is permitted to order and refer services to other healthcare providers.

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.: 3819T962
License State: OH
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.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Blue Cross and Blue Shield of Louisiana

Blue Max 70/50 $6700 - PPO
Blue Max 90/70 $1500 - PPO
Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $3300 - PPO
Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan - PPO
Blue Max Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan - PPO
Blue Max Copay (PCP, Specialist, Urgent Care) 75/55 $1500 Standardized Plan - PPO
Blue Saver 60/40 $6100 - PPO
Blue Saver 90/70 $3200 - PPO

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

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
T93953	MEDICARE UPIN (02)
PR0683971	MEDICARE ID-TYPE UNSPECIFIED (04)

Medicare Participation & PECOS Enrollment Status

John Pratt is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME) and a Home Health Agency (HHA).

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

Is the provider registered in PECOS? Yes
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 06-23-2016
Opt-Out End Date: 06-23-2026
Eligible to Order and Refer? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: No

Physician Visit Costs

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 43050 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99204

Average New Patient Price $126.12
Minimum New Patient Price $54.34
Maximum New Patient Price $166.65

Average New Patient Copayment $31.53
Minimum New Patient Copayment $13.58
Maximum New Patient Copayment $41.66

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

Average Established Patient Price $68.07
Minimum Established Patient Price $17.1
Maximum Established Patient Price $135.4

Average Established Patient Copayment $17.01
Minimum Established Patient Copayment $4.27
Maximum Established Patient Copayment $33.85

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1	7	3	0	2	8	9	3	1	5
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	7	6	0	4	8	18	3	2
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 7 + 6 + 0 + 4 + 8 + 1 + 8 + 3 + 2 + 24 = 65
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 65 = 5									5

The NPI number 1730289315 is valid because the calculated check digit 5 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location

The following 12 providers are registered at the same or nearby location.

WAL-MART STORES EAST LP

Pharmacy

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