Christa Marie Widjaja, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

9933 Issued in TX

Practice address

5900 Coit Rd
Plano, TX 75023-5959

Phone

(972) 985-1412

NPI assigned

Jul 30, 2020

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

Medicare fee-for-service enrollment

Enrolled in TX

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

University of Houston - College of Optometry, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Plano Eye Associates PCGroup PAC ID 3072575349, 8 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

93.66 of 100Reported as individual

Quality

87.32

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: christa.widjaja@uprisedirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Plano Eye Associates PC

  • Optometrist
  • Plano, TX
  • NPI 1750581864
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1053920546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 COIT RD",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750235959",
            "telephone_number": "972-985-1412",
            "fax_number": "972-945-2125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 COIT RD",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750235959",
            "telephone_number": "972-985-1412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDJAJA",
        "first_name": "CHRISTA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-30",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "9933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4215477",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nathan Drew Wibisono, PT, DPT
• Jacqueline Babbs Wiebe, PH.D
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• Sheryl Lynn Wiedermann, AU.D, CCC-A
• Todd Mitchell Wien, MD
• Brittany Wierman, LPC

• Optometrist in Plano, TX
• Providers in Plano, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.