Shane Jensen, O.D.
Individual provider Active NPI Optometrist · Panguitch, UT
NPI 1154422822 · NPPES record last updated Jun 16, 2008
Key facts
- NPI
- 1154422822
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 5354482-9934 (UT)
- Practice address
- 415 E. Center Street
Panguitch, UT 84759 - Phone
- (435) 676-8646
- Fax
- (435) 676-8646
- NPI assigned
- Sep 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Pacific University - College of Optometry, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Eastern Utah Eye Physicians
Practice addresses (Care Compare)
200 N Fairgrounds Rd
Suite 2
Price, UT 84501-4228
Phone (435) 637-8689
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- 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 |
|---|---|---|---|---|
| I20040117000211 | UT | Practitioner - Optometry | 6204737737 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5354482-9934 | UT | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eastern Utah Eye Physicians | Current |
Accepting new patients | |
| Southwest Vision, LLC | Optometrist | Past | Accepting new patients |
| Shane R Jensen | Optometrist | Past |
Accepting new patients |
Locations
200 N Fairgrounds Rd
Ste 2
Price, UT 84501
Phone (435) 637-7860
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 5354482-9934 | UT | Yes |
Addresses
Primary practice location
415 E. Center Street
Panguitch, UT 84759
Mailing address
P.O. Box 592
Panguitch, UT 84759
Phone (435) 676-2761
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 53544829900001 | Other | UT | BLUECROSS BLUESHIELD |
| 043753766 | Other | UT | TRICARE |
| D5075 | Medicaid | UT | |
| 043753766 | Other | UT | HUMANA |
| 5354482-9934 | Other | UT | PEHP |
| 107028627101 | Other | UT | IHC |
| RR27009 | Other | UT | SPECTERA |
| 270343 | Other | UT | ALTIUS |
| 1595696 | Other | UT | OPTICHOICE |
| 813540 | Other | UT | DMBA |
Other providers in Panguitch, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2008. 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.