Derek Hennig, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046011094 Issued in IL

Practice address

1700 18TH St
Charleston, IL 61920-3607

Phone

(217) 345-6600

Fax

(217) 345-6622

NPI assigned

Jun 6, 2017

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 IL

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 College of Optometry, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lifetime Eye Care PCGroup PAC ID 0244634541, 3 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

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 and National Provider Directory roles.

• Lifetime Eye Care, P. C.

  • Optometrist
  • Charleston, IL
  • NPI 1205424900
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1496707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496707200000",
    "number": "1215466008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 18TH ST",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619203607",
            "telephone_number": "217-345-6600",
            "fax_number": "217-345-6622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 18TH ST",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619203607",
            "telephone_number": "217-345-6600",
            "fax_number": "217-345-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENNIG",
        "first_name": "DEREK",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-06",
        "last_updated": "2017-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046011094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heartland Family Dental Care of Illinois, PC
• Kathleen A. Hecksel, M.D.
• Jason Heiar, ATC
• Morgan Elizabeth Helbig, APRN
• Sarah Katherine Henderson
• Jennifer Hess, MS, ATC
• Highland Park CVS LLC
• Amanda Nicole Hilderbrand, MS CCC SLP
• Hilltop Care and Rehabilitation Center LLC
• Hilltop Care and Rehabilitation Center LLC

• Optometrist in Charleston, IL
• Providers in Charleston, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2017; 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.