Jesse Fenstermacher, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3701 Issued in MN

Practice address

922 US 10 E
Staples, MN 56479-2371

Phone

(218) 894-1331

NPI assigned

Sep 3, 2020

Last updated

Sep 3, 2020By the provider in NPPES

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 MN

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

Southern California College of Optometry, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Staples Eye Clinic PSCGroup PAC ID 1759540222, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Staples Eye Clinic PSC

  • Optometrist
  • Staples, MN
  • NPI 1821366683
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1599091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599091200000",
    "number": "1194339481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "922 US 10 E",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "564792371",
            "telephone_number": "218-894-1331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "922 US 10 E",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "564792371",
            "telephone_number": "218-894-1331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENSTERMACHER",
        "first_name": "JESSE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-03",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mattie Rose Ellenson, APRN, CNP
• Jody Ellingson, PHARM.D
• Kirstina Emans, MSW, LICSW
• Essentially Life LLC (Old School Health)
• Essilor Laboratories of America, Inc (Twin City Optical)
• Madecyn Caroline Franz
• David Allan Freeman, M.D.
• Fresenius Medical Care Centracare Dialysis, LLC (Fresenius Kidney Care Wadena County)
• Mitchell Jonathan Fritz, PSYD, LP
• Dominic Joseph Gagnon, DDS

• Optometrist in Staples, MN
• Providers in Staples, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2020; 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.