Michelle Derheimer

Primary specialty

OptometristTaxonomy code 152W00000X

License

2013025320 Issued in MO

Practice address

12990 Manchester Rd
Suite 201
Des Peres, MO 63131-1860

Phone

(314) 909-0633

Fax

(314) 909-0391

NPI assigned

Jul 16, 2013

Last updated

Jul 16, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Michelle Fondell Former name

Medicare fee-for-service enrollment

Enrolled in MO

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

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ophthalmology Consultants LLCGroup PAC ID 6800884008, 22 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

79.58 of 100Reported as group

Quality

80.09

Promoting interoperability

88

Improvement activities

40

Cost

61.86

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: michelle.derheimer.p1@direct.ocltd.nextgenshare.com
• Direct secure messaging: michelle.derheimerod.p2@direct.ocltd.nextgenshare.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.

• Ophthalmology Consultants, LLC

  • Ophthalmology Physician
  • Des Peres, MO
  • NPI 1508899543
  Medicare reassignment Care Compare group
• Finklang Eye Health Associates, LLC

  • Optometrist
  • Troy, MO
  • NPI 1215061957
  NPD (past)

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

{
    "created_epoch": "1373932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373932800000",
    "number": "1265873475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12990 MANCHESTER RD",
            "address_2": "SUITE 201",
            "city": "DES PERES",
            "state": "MO",
            "postal_code": "631311860",
            "telephone_number": "314-909-0633",
            "fax_number": "314-909-0391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12990 MANCHESTER RD",
            "address_2": "SUITE 201",
            "city": "DES PERES",
            "state": "MO",
            "postal_code": "631311860",
            "telephone_number": "314-909-0633",
            "fax_number": "314-909-0391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERHEIMER",
        "first_name": "MICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-16",
        "last_updated": "2013-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2013025320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTOMETRIC LICENSE",
            "identifier": "2013025320",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "FONDELL",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Des Peres Urgent Care, LLC (MedPost Urgent Care - Des Peres)
• Dierbergs Markets Inc (Dierbergs Des Peres)
• Karen Dittmer, NP

• Optometrist in Des Peres, MO
• Providers in Des Peres, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2013; 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.