Individual provider Active NPI

Jessica M Hall, OD

  • Optometrist
  • Huntingtown, MD
National Provider Identifier
1366490401
Registry record updated Mar 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
8854T Issued in TX
Practice address
28 Cox Rd
Huntingtown, MD 20639-9278
Phone
(410) 414-9456
NPI assigned
May 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 8854T TX Primary

Addresses

Primary practice location

28 Cox Rd
Huntingtown, MD 20639-9278

Mailing address

2790 SW Wilshire Blvd
Burleson, TX 76028-8338
Phone (817) 484-2020

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160311000440 TX Practitioner - Optometry 5890968655 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2003
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2790 SW Wilshire Blvd
Burleson, TX 76028-8338

Merit-based Incentive Payment System (MIPS)

Final score
92.37 of 100Reported as group
Quality
100
Improvement activities
40
Cost
74.56

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8854TTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Berry Eye Center PA CurrentSince Mar 10, 2016 Accepting new patients
Huntingtown Vision Center, LLC Optometrist Past Accepting new patients

Locations

2790 SW Wilshire Blvd
Burleson, TX 76028
Phone (817) 484-2020

12001 South Fwy
Ste 101
Burleson, TX 76028
Phone (807) 615-4400

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456790400000",
    "number": "1366490401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2790 SW WILSHIRE BLVD",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760288338",
            "telephone_number": "817-484-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 COX RD",
            "city": "HUNTINGTOWN",
            "state": "MD",
            "postal_code": "206399278",
            "telephone_number": "410-414-9456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "JESSICA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2016-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "8854T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntingtown, MD

Sources for this page

Verify at the official NPI Registry.