Rebecca V St Jean, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

989OD Issued in WV

Practice address

4030 Maccorkle Ave SW
South Charleston, WV 25309-1510

Phone

(304) 766-2220

Fax

(304) 766-0824

NPI assigned

Sep 16, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WV

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, 1997

Medicare assignment

May accept Medicare assignment

Group practices

Rebecca St Jean OD IncGroup PAC ID 4789720053, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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.

• Rebecca St Jean OD Inc

  • Optometrist
  • South Charleston, WV
  • NPI 1053586008
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207267200000",
    "number": "1215922174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4030 MACCORKLE AVE SW",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091510",
            "telephone_number": "304-766-2220",
            "fax_number": "304-766-0824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4030 MACCORKLE AVE SW",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091510",
            "telephone_number": "304-766-2220",
            "fax_number": "304-766-0824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ST JEAN",
        "first_name": "REBECCA",
        "middle_name": "V",
        "name_prefix": "Mrs.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-16",
        "last_updated": "2008-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WV",
            "license": "989OD",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7230192",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARELINK",
            "identifier": "132743",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandi Spicer
• Spring Hill Primary Care Physicians PLLC
• Angela Sprinkles
• Ashley L. Spruce, M.A.
• Latasha Spry, PRSS
• Jeanette St. John
• Lara St. John
• Shed Stacy
• Tabitha Renee Stacy
• Katlin Stalnaker

• Optometrist in South Charleston, WV
• Providers in South Charleston, WV by specialty
• Optometrist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2008; 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.