Active NPI
Jenna Vergeldt, OD
- Optometrist
- Oklahoma City, OK
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 10401T
- Practice address
- 921 NE 13TH St
Oklahoma City, OK 73104-5007 - Phone
- (405) 456-4017
- NPI assigned
- Feb 6, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 10401T | TX | Primary |
Addresses
Primary practice location
921 NE 13TH St
Oklahoma City, OK 73104-5007
Mailing address
2034 Town Road 492
International Falls, MN 56649-8707
Phone (218) 417-0739
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Southern California College of Optometry, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
7670 Quarterfield Rd
Glen Burnie, MD 21061-3947
Phone (410) 508-7650
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10401T | TX | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Current | Accepting new patients | |
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Current | Accepting new patients | |
| Kaiser Foundation Health Plan of the Mid Atlantic States, Inc | Current | Accepting new patients |
Locations
7070 Samuel Morse Dr
Columbia, MD 21046
Phone (410) 309-4600
7670 Quarterfield Rd
Ofc
Glen Burnie, MD 21061
Phone (410) 508-7650
4000 Garden City Dr
Fl 4
Hyattsville, MD 20785
Phone (227) 229-8532
2101 E Jefferson St
#4E
Rockville, MD 20852
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 and National Provider Directory roles.
-
- Health Maintenance Organization
- Halethorpe, MD
- NPI 1043378656
-
- Health Maintenance Organization
- Abingdon, MD
- NPI 1265971873
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Rockville, MD
- NPI 1962108753
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658966400000",
"number": "1053943258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2034 TOWN ROAD 492",
"city": "INTERNATIONAL FALLS",
"state": "MN",
"postal_code": "566498707",
"telephone_number": "218-417-0739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "921 NE 13TH ST",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731045007",
"telephone_number": "405-456-4017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VERGELDT",
"first_name": "JENNA",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-02-06",
"last_updated": "2022-07-28",
"certification_date": "2022-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TX",
"license": "10401T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; 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.