Jordan Scott Ewert, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2728 Issued in OK

Practice address

2109 N Kickapoo Ave
Shawnee, OK 74804-2732

Phone

(405) 275-2020

Fax

(405) 275-4129

NPI assigned

Jul 24, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

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

Specialty

Optometry

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Family Eye Care of Shawnee PLLC

  • Optometrist
  • Shawnee, OK
  • NPI 1316335615
  Medicare reassignment

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

{
    "created_epoch": "1343088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476835200000",
    "number": "1124374426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2109 N KICKAPOO AVE",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748042732",
            "telephone_number": "405-275-2020",
            "fax_number": "405-275-4129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 N KICKAPOO AVE",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748042732",
            "telephone_number": "405-275-2020",
            "fax_number": "405-275-4129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EWERT",
        "first_name": "JORDAN",
        "middle_name": "SCOTT",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-24",
        "last_updated": "2016-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2728",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200463520A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Regina Sioux Ertz, PH.D.
• Ryan Esselstrom
• Eternal Kingdom Enterprises Inc.
• Eternal Kingdom Enterprises, Inc.
• Rylee Evans, SLP
• Faith 7 Activity Center
• Family Eye Care of Shawnee PLLC
• Family Healthcare Associates PLLC
• Family Medicine Specialists, P.C.
• Dana Darlene Farriell, MASTERS COUNSELING

• Optometrist in Shawnee, OK
• Providers in Shawnee, OK by specialty
• Optometrist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.