Anisha Jacob, O.D

Primary specialty

OptometristTaxonomy code 152W00000X

License

046010568 Issued in IL

Practice address

106 East Barnett Ave
Forsyth, IL 62535

Phone

(217) 877-7900

NPI assigned

Jul 18, 2012

Last updated

Jul 18, 2012By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in TX

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

Illinois College of Optometry at Chicago, 2012

Medicare assignment

May accept Medicare assignment

Group practices

Village Vision Center, PLLCGroup PAC ID 9133402738, 6 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: anisha.jacob.1@16194.direct.athenahealth.com

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.

• Village Vision Center, PLLC

  • Optometrist
  • Highland Village, TX
  • NPI 1841742558
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1342569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342569600000",
    "number": "1265787998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18920 SPRINGFIELD AVE",
            "city": "FLOSSMOOR",
            "state": "IL",
            "postal_code": "604221072",
            "telephone_number": "708-969-3218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 EAST BARNETT AVE",
            "city": "FORSYTH",
            "state": "IL",
            "postal_code": "62535",
            "telephone_number": "217-877-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "ANISHA",
        "name_prefix": "Dr.",
        "credential": "O.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-18",
        "last_updated": "2012-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Giers, LCPC
• Healthy Soles Inc
• Hickory Point Christian Village, Inc. (Hickory Point Christian Village)
• Hickory Point Fire Protection Dist
• HW Holdings (All About Eyes)
• Lake of Decatur, Inc (Colee's Corner Drugs)
• Elizabeth Lambdin, FNP-BC
• Steven H Lane, OD
• Cynthia Marie Lewis, ED.D.
• Natasha Loera

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2012; 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.