NPIMap

Individual provider Active NPI

Jaclyn Deann Rouse, O.D.

  • Optometrist
  • Hugo, OK
National Provider Identifier
1063898161
Registry record updated Feb 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2855 Issued in OK
Practice address
410 North M Street
Hugo, OK 74743
Phone
(580) 326-7561
Fax
(580) 326-7564
NPI assigned
Jul 31, 2015
Last updated
Feb 12, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 12, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2855 OK Primary

Addresses

Primary practice location

410 North M Street
Hugo, OK 74743

Mailing address

410 North M Street
Hugo, OK 74743
Phone (580) 326-7561

Other names 1

  • Jaclyn Deann Hicks Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151123001529 TX Practitioner - Optometry 5991005050 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Choctaw Nation of OklahomaGroup PAC ID 1759294838, 271 clinicians

Practice addresses (Care Compare)

1 Choctaw Way
Talihina, OK 74571-2022
Phone (539) 316-6391

410 N M St
Choctaw Nation Health Care Hugo
Hugo, OK 74743-1820
Phone (539) 316-6391

One Choctaw Way
Talihina, OK 74571-2022

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.07 of 100Reported as group
Quality
73.06
Improvement activities
40
Cost
69.92

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2855OKMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Choctaw Nation of Oklahoma CurrentSince Sep 8, 2015 Accepting new patients
Choctaw Nation of Oklahoma CurrentSince Sep 8, 2015 Accepting new patients
Choctaw Nation of Oklahoma Current Accepting new patients

Locations

410 N M St
Hugo, OK 74743
Phone (580) 326-7561

1 Choctaw Way
Talihina, OK 74571
Phone (918) 423-8440

Interoperability endpoints

  • Direct secure messaging: jrouse19417@choctawnation.direct-ci.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1438300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549929600000",
    "number": "1063898161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 NORTH M STREET",
            "city": "HUGO",
            "state": "OK",
            "postal_code": "74743",
            "telephone_number": "580-326-7561",
            "fax_number": "580-326-7564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 NORTH M STREET",
            "city": "HUGO",
            "state": "OK",
            "postal_code": "74743",
            "telephone_number": "580-326-7561",
            "fax_number": "580-326-7564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUSE",
        "first_name": "JACLYN",
        "middle_name": "DEANN",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-31",
        "last_updated": "2019-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "HICKS",
            "middle_name": "DEANN",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Hugo, OK

Sources for this page

Verify at the official NPI Registry.