Individual provider Active NPI

Jason Richard Diehl, O.D.

  • Optometrist
  • Columbia, IL
National Provider Identifier
1003875147
Registry record updated Oct 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046-009550 Issued in IL
Practice address
1025 Columbia Ctr
Columbia, IL 62236-2546
Phone
(618) 281-8611
Fax
(618) 281-3927
NPI assigned
Mar 18, 2006
Last updated
Oct 2, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046-009550 IL Primary

Addresses

Primary practice location

1025 Columbia Ctr
Columbia, IL 62236-2546

Mailing address

40 E North St
Eureka, MO 63025-1205
Phone (636) 200-4393

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20041106000072 IL Practitioner - Optometry 9931162476 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Missouri St Louis - School of Optometry, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clarkson Optometry Illinois, PCGroup PAC ID 7012292147, 16 clinicians

Practice addresses (Care Compare)

1025 Columbia Ctr
Columbia, IL 62236-2546
Phone (618) 281-8611

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046-009550ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Clarkson Optometry Illinois, P.C. Optometrist CurrentSince Mar 29, 2017 Accepting new patients
Clarkson Optometry Illinois, P.C. Optometrist CurrentSince Mar 29, 2017 Accepting new patients
Nu-Crown, LLC Optometrist Past Accepting new patients

Locations

1025 Columbia Centre
Columbia, IL 62236
Phone (618) 281-8611

6663 Edwardsville Crossing Dr
#B
Edwardsville, IL 62025
Phone (618) 659-2320

3405 Nameoki Rd
Ste A
Granite City, IL 62040
Phone (618) 219-8909

3248 Green Mount Crossing Dr
Shiloh, IL 62269
Phone (618) 622-9225

204 Bradford Ln
Waterloo, IL 62298
Phone (618) 939-6163

15933 Clayton Rd
Ste 201
Ballwin, MO 63011

Networks

  • IL PPO Downstate
  • devoted network organization-27eb9117-6975-449a-a7ad-909243995ddc
  • devoted network organization-734447cc-691b-4aa7-a112-9c9c8698dcc9
  • IL HMO C-SNP
  • devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806

Interoperability endpoints

  • Direct secure messaging: jasondiehl@direct.eyecare-partners.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1142640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412208000000",
    "number": "1003875147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 E NORTH ST",
            "city": "EUREKA",
            "state": "MO",
            "postal_code": "630251205",
            "telephone_number": "636-200-4393",
            "fax_number": "636-938-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 COLUMBIA CTR",
            "city": "COLUMBIA",
            "state": "IL",
            "postal_code": "622362546",
            "telephone_number": "618-281-8611",
            "fax_number": "618-281-3927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIEHL",
        "first_name": "JASON",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-18",
        "last_updated": "2014-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-009550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, IL

Sources for this page

Verify at the official NPI Registry.