Derek P. Jacobsen

Primary specialty

OptometristTaxonomy code 152W00000X

License

1933 Issued in AZ

Practice address

13613 W Camino del Sol Ste 2
Sun City West, AZ 85375-4480

Phone

(623) 584-2100

Fax

(623) 584-0023

NPI assigned

Apr 29, 2013

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

Medicare fee-for-service enrollment

Enrolled in AZ

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, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Scottsdale Center for Sight, PLC 9 clinicians

Emilio Martin Justo MD PC 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Emilio Martin Justo MD PC

  • Ophthalmology Physician
  • Sun City, AZ
  • NPI 1801902762

  AZ

  Medicare reassignment Care Compare group NPD
• Scottsdale Center for Sight, PLC

  • Ophthalmology Physician
  • Scottsdale, AZ
  • NPI 1265591374

  AZ

  Medicare reassignment Care Compare group NPD
• Nationwide Optometry P.C.

  • Optometrist
  • Tempe, AZ
  • NPI 1326472945

  AZ

  Medicare reassignment
• Nationwide Optometry P.C.

  • Optometrist
  • Gilbert, AZ
  • NPI 1023691250
  NPD (past)
• Nationwide Optometry P.C.

  • Optometrist
  • Phoenix, AZ
  • NPI 1073683348
  NPD (past)
• Priority Hearing and Balance LLC

  • Audiologist
  • San Tan Valley, AZ
  • NPI 1962882746
  NPD (past)
• Tara Ransdell OD PLLC

  • Optometrist
  • Peoria, AZ
  • NPI 1104914316
  NPD (past)

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

{
    "created_epoch": "1367193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614556800000",
    "number": "1124462593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14269 N 87TH ST STE 203",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852603695",
            "telephone_number": "480-483-8882",
            "fax_number": "480-419-5401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13613 W CAMINO DEL SOL STE 2",
            "city": "SUN CITY WEST",
            "state": "AZ",
            "postal_code": "853754480",
            "telephone_number": "623-584-2100",
            "fax_number": "623-584-0023"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7727 W Deer Valley Rd Ste E200",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "AZ",
            "postal_code": "853822114",
            "country_code": "US",
            "telephone_number": "623-376-9070",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18325 N Allied Way",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850543105",
            "country_code": "US",
            "telephone_number": "602-467-4966",
            "fax_number": "480-419-5401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "DEREK",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-29",
        "last_updated": "2021-03-01",
        "certification_date": "2021-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "1933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Integrity Medical Supplies, LLC
• Iora Senior Health, LLC
• Joseph Jabrucki, DPT
• Jack Luftman BSC DDS PC
• Jkiya Jackson, PHARMD
• Joel A Jacobson, MD
• Syed Ismail Ali Jafri, M.D.
• James T Cooper MD PC
• Shawn Jaramillo, PHARM. D
• Jdfa PLLC

• All providers in Sun City West, AZ
• Optometrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2021; 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.