Jeanne Ruth Derber, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1161 Issued in CO

Practice address

9240 Explorer Dr Ste 100
Colorado Springs, CO 80920-5004

Phone

(719) 574-7000

Fax

(719) 597-1712

NPI assigned

Mar 17, 2006

Last updated

Jun 3, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jeanne R Derber Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CO

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

Specialty

Optometry

Education

Pennsylvania College of Optometry, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Executive Park Eye Care PLLCGroup PAC ID 8022916220, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: direct@executiveparkeyecarepllccoloradospringsco.compulinkdirect.com

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.

• Executive Park Eye Care, PLLC

  • Optometrist
  • Colorado Springs, CO
  • NPI 1528156734
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622678400000",
    "number": "1013976224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9240 EXPLORER DR STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809205004",
            "telephone_number": "719-574-7000",
            "fax_number": "719-597-1712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9240 EXPLORER DR STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809205004",
            "telephone_number": "719-574-7000",
            "fax_number": "719-597-1712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERBER",
        "first_name": "JEANNE",
        "middle_name": "RUTH",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-17",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "1161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08116105",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Direct@ExecutiveParkEyecarePLLCColoradoSpringsCO.CompulinkDirect.com",
            "affiliation": "N",
            "endpointDescription": "Practice direct email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "9240 Explorer Dr Ste 100",
            "city": "Colorado Springs",
            "state": "CO",
            "country_code": "US",
            "postal_code": "809205004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JEANNE",
            "last_name": "DERBER",
            "middle_name": "R",
            "credential": "O.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Daniel Depperman, NCMMT, CERT ROLFER
• Caroline Deprisco, M.D.
• Dept of Veterans Affairs
• Karissa Ruth Deptula, PT, DPT
• Claudia Yovana Deras Flores
• Kelly Dering, DNP, FNP-C, WHNP
• Jon Eric Derksen, M.D.
• Leah Derksen, NP
• Dermatology Clinic, P.C.
• Susan Gabrielle Dern, DO

• Optometrist in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Optometrist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.