Lexi Derry, O.D.
Individual provider Active NPI Optometrist · Watertown, WI
NPI 1063709491 · NPPES record last updated Aug 25, 2022
Key facts
- NPI
- 1063709491
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 3659-35 (WI)
- Practice address
- 123 Hospital Dr
Watertown, WI 53098-3331 - Phone
- (202) 618-2259
- Fax
- (920) 261-5343
- NPI assigned
- Jul 6, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 5
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Watertown Physician Practices LLC
Practice addresses (Care Compare)
123 Hospital Dr
Watertown, WI 53098-3320
1507 Doctors CT
Watertown, WI 53094-4101
Phone (920) 261-4111
Hospital & facility affiliations
- Watertown Memorial Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170109000088 | TX | Practitioner - Optometry | 4183847189 | |
| I20210213000104 | WI | Practitioner - Optometry | 4183847189 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8855 | TX | MD | Professional Counselor |
| 046.010474 | IL | MD | Optometrist |
| 855TG | TX | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Watertown Physician Practices LLC | Current |
Accepting new patients | |
| Watertown Physician Practices LLC | Current |
Accepting new patients | |
| Watertown Physician Practices LLC | Current | Accepting new patients | |
| Visionworks Inc | Past |
Accepting new patients | |
| Northlake Family Eyecare PLLC | Optometrist | Past |
Accepting new patients |
Locations
330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780
123 Hospital Dr
Watertown, WI 53098
Phone (920) 262-4412
123 Hospital Dr
Ste 1002
Watertown, WI 53098
Phone (920) 261-8225
1507 Doctors Ct
Watertown, WI 53094
Phone (920) 261-4111
Interoperability endpoints
- lexi.derry.1@17022.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046.010474 | IL | |
| Optometrist | 152W00000X | 855TG | TX | |
| Optometrist | 152W00000X | 3659-35 | WI | Yes |
Addresses
Primary practice location
123 Hospital Dr
Watertown, WI 53098-3331
Mailing address
123 Hospital Dr
Watertown, WI 53098-3331
Phone (217) 841-4810
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 046010474 | Medicaid | IL |
Other providers in Watertown, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.