Individual provider Active NPI

Heidi Lynn Schefferly, O.D.

  • Optometrist
  • Jackson, MI
National Provider Identifier
1063403632
Registry record updated Dec 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901003898 Issued in MI
Practice address
306 W Washington Ave
Suite 104
Jackson, MI 49201-2169
Phone
(517) 783-6928
NPI assigned
Nov 2, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901003898 MI Primary

Addresses

Primary practice location

306 W Washington Ave
Suite 104
Jackson, MI 49201-2169

Mailing address

4877 W Territorial Rd
Rives Junction, MI 49277-9639
Phone (517) 589-5062

Other identifiers 5

IdentifierTypeStateIssuer
410045602OtherMIPALMETTO GBA RR MEDICARE
BCBS OF MICHIGANOtherMI900C865230
1312340001OtherMIDMERC
VCM-0149OtherMIM-CARE
22-20000OtherMIPHP OF SOUTHERN MICHIGAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20080828000122 MI Practitioner - Optometry 8325114390 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

350 N Wisner St
Jackson, MI 49202-4225
Phone (517) 783-6928

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Heidi Schefferly OD PLLC Optometrist CurrentSince Jan 1, 2008 Accepting new patients
James P. Serino, O.D. P.C. Optometrist PastSince Apr 1, 2007 Accepting new patients

Locations

350 N Wisner St
Jackson, MI 49202
Phone (517) 783-6928

306 W Washington Ave
Ste 104
Jackson, MI 49201
Phone (517) 783-6928

Interoperability endpoints

  • Direct secure messaging: hschefferly546923@direct.hfhs.org

Organizations & group practices 2

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": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387238400000",
    "number": "1063403632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4877 W TERRITORIAL RD",
            "city": "RIVES JUNCTION",
            "state": "MI",
            "postal_code": "492779639",
            "telephone_number": "517-589-5062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 W WASHINGTON AVE",
            "address_2": "SUITE 104",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012169",
            "telephone_number": "517-783-6928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHEFFERLY",
        "first_name": "HEIDI",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2013-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA  RR MEDICARE",
            "identifier": "410045602",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "900C865230",
            "identifier": "BCBS OF MICHIGAN",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "1312340001",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "M-CARE",
            "identifier": "VCM-0149",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP OF SOUTHERN MICHIGAN",
            "identifier": "22-20000",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.