Jason Richard Diehl, O.D.
Individual provider Active NPI Optometrist · Columbia, IL
NPI 1003875147 · NPPES record last updated Oct 2, 2014
Key facts
- NPI
- 1003875147
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 046-009550 (IL)
- Practice address
- 1025 Columbia Ctr
Columbia, IL 62236-2546 - Phone
- (618) 281-8611
- Fax
- (618) 281-3927
- NPI assigned
- Mar 18, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- 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, PC
Practice addresses (Care Compare)
1025 Columbia Ctr
Columbia, IL 62236-2546
Phone (618) 281-8611
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041106000072 | IL | Practitioner - Optometry | 9931162476 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046-009550 | IL | MD | Optometrist |
Practice roles (3 of 8)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clarkson Optometry Illinois, P.C. | Optometrist | Current |
Accepting new patients |
| Clarkson Optometry Illinois, P.C. | Optometrist | Current |
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 HMO C-SNP
- devoted network organization-27eb9117-6975-449a-a7ad-909243995ddc
- devoted network organization-734447cc-691b-4aa7-a112-9c9c8698dcc9
- IL PPO Downstate
- devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806
Interoperability endpoints
- jasondiehl@direct.eyecare-partners.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046-009550 | IL | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00397557 | Other | IL | RAILROAD MEDICARE |
Other providers in Columbia, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.