Individual provider Active NPI

Diane Marie Jessen, O.D.

  • Optometrist
  • Wentzville, MO
National Provider Identifier
1063573400
Registry record updated Oct 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2005019956 Issued in MO
Practice address
1894 Wentzville Pkwy
Wentzville, MO 63385-3820
Phone
(636) 377-2054
Fax
(636) 377-2056
NPI assigned
Dec 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2005019956 MO Primary

Addresses

Primary practice location

1894 Wentzville Pkwy
Wentzville, MO 63385-3820

Mailing address

15933 Clayton Rd
Suite 201
Ballwin, MO 63011-2172
Phone (636) 200-4393

Other identifiers 1

IdentifierTypeStateIssuer
1063573400MedicaidMO

Other names 1

  • Diane Marie Curry Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20051020000285 MO Practitioner - Optometry 8426074329 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clarkson Optometry IncGroup PAC ID 0840411799, 82 clinicians

Practice addresses (Care Compare)

1894 Wentzville Pkwy
Wentzville, MO 63385-3820
Phone (636) 887-4000

3122 S Grand Blvd
The Spec Shoppe
St Louis, MO 63118-1012
Phone (314) 450-7313

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2005019956MOMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Clarkson Optometry Inc Optometrist CurrentSince Sep 16, 2014 Accepting new patients
Clarkson Optometry, Inc Optometrist CurrentSince Sep 16, 2014 Accepting new patients
Clarkson Eyecare Optometrist Past Accepting new patients

Locations

6313 Ronald Reagan Dr
Lake St Louis, MO 63367
Phone (636) 561-2342

330 W Osage St
Pacific, MO 63069
Phone (636) 271-4500

3122 S Grand Blvd
Saint Louis, MO 63118
Phone (314) 450-7313

11433 Olive Blvd
Saint Louis, MO 63141
Phone (314) 432-1134

514 Warren County Ctr
Warrenton, MO 63383
Phone (636) 377-2054

1894 Wentzville Pkwy
Wentzville, MO 63385
Phone (636) 887-4000

Interoperability endpoints

  • Direct secure messaging: dianemjessen@direct.eyecare-partners.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": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445990400000",
    "number": "1063573400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15933 CLAYTON RD",
            "address_2": "SUITE 201",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630112172",
            "telephone_number": "636-200-4393",
            "fax_number": "636-938-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1894 WENTZVILLE PKWY",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633853820",
            "telephone_number": "636-377-2054",
            "fax_number": "636-377-2056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JESSEN",
        "first_name": "DIANE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-12",
        "last_updated": "2015-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2005019956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063573400",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANE",
            "last_name": "CURRY",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wentzville, MO

Sources for this page

Verify at the official NPI Registry.