Individual provider Active NPI

Janessa Patel, OD

  • Optometrist
  • Jacksonville, FL
National Provider Identifier
1063165108
Registry record updated Feb 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
6362 Issued in FL
Practice address
11512 Lake Mead Ave Unit 534
Jacksonville, FL 32256-5835
Phone
(904) 564-2020
NPI assigned
Jan 29, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 26, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5529 MA
Optometrist 152W00000X 6362 FL Primary

Addresses

Primary practice location

11512 Lake Mead Ave Unit 534
Jacksonville, FL 32256-5835

Mailing address

11512 Lake Mead Ave Unit 534
Jacksonville, FL 32256-5835
Phone (904) 564-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220621002206 MA Practitioner - Optometry 6305225434 Reassigns benefits to 1 organization
I20250313000749 FL Practitioner - Optometry 6305225434 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Florida Surgeons PAGroup PAC ID 2769381391, 336 clinicians

Practice addresses (Care Compare)

11512 Lake Mead Ave
Suite 534
Jacksonville, FL 32256-5835
Phone (904) 642-2222

Merit-based Incentive Payment System (MIPS)

Final score
94.01 of 100Reported as group
Quality
92.29
Improvement activities
40
Cost
73.65

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6362FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Longwood Eye, LLC Optometrist CurrentSince Jun 3, 2022 Accepting new patients
North Florida Surgeons, PA CurrentSince Feb 14, 2025 Accepting new patients
North Florida Surgeons, PA CurrentSince Feb 14, 2025 Accepting new patients

Locations

11945 San Jose Blvd
Ste 300
Jacksonville, FL 32223

11512 Lake Mead Ave
Unit 534
Jacksonville, FL 32256
Phone (904) 564-2020

11945 San Jose Blvd
Ste 102
Jacksonville, FL 32223
Phone (904) 268-3937

33 Riddell St
Ste 2
Greenfield, MA 01301
Phone (413) 286-2020

33 Riddell St
Greenfield, MA 01301
Phone (413) 772-0853

180 Daggett Dr
West Springfield, MA 01089
Phone (413) 286-2020

Interoperability endpoints

  • Direct secure messaging: janessa.patel.1@9109.direct.athenahealth.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1643414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740528000000",
    "number": "1063165108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11512 LAKE MEAD AVE UNIT 534",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322565835",
            "telephone_number": "904-564-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11512 LAKE MEAD AVE UNIT 534",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322565835",
            "telephone_number": "904-564-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "JANESSA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-29",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "5529",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "6362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.