Active NPI
Jessa Marie Vankleeck, OD
- Optometrist
- Newport Beach, CA
National Provider Identifier
1255991840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT34433TLG
- Practice address
- 522 Old Newport Blvd
Newport Beach, CA 92663-4212 - Phone
- (949) 650-9060
- NPI assigned
- Jun 17, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TUV008978 | NY | |
| Optometrist | 152W00000X | OPT34433TLG | CA | Primary |
Addresses
Primary practice location
522 Old Newport Blvd
Newport Beach, CA 92663-4212
Mailing address
522 Old Newport Blvd
Newport Beach, CA 92663-4212
Phone (949) 650-9060
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX, CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- State University of New York - State College Optometry, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
522 Old Newport Blvd
Newport Beach, CA 92663-4212
Phone (949) 650-9060
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34433 | CA | MD | Marriage & Family Therapist |
| OPT34433TLG | CA | MD | Optometrist |
| TUV008978 | NY | MD | Optometrist |
Practice roles
Locations
522 Old Newport Blvd
Newport Beach, CA 92663
Phone (949) 644-1112
Interoperability endpoints
- https://api.platform.athenahealth.com/16772/brand/1/csg/1/fhir/r4
Organizations & group practices 24
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584576000000",
"number": "1255991840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "522 OLD NEWPORT BLVD",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926634212",
"telephone_number": "949-650-9060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "522 OLD NEWPORT BLVD",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926634212",
"telephone_number": "949-650-9060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANKLEECK",
"first_name": "JESSA",
"middle_name": "MARIE",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-06-17",
"last_updated": "2020-03-19",
"certification_date": "2020-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "TUV008978",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT34433TLG",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Newport Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 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.