Jesse Jacob Fertig, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV007355 Issued in NY

Practice address

12430 Queens Blvd
Kew Gardens, NY 11415-1501

Phone

(718) 261-2344

NPI assigned

Aug 19, 2006

Last updated

Mar 6, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, FL, VA3 enrollments

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 3

Specialty

Optometry

Education

State University of New York - State College Optometry, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

93.07 of 100Reported as apm

Quality

79.77

Promoting interoperability

88.77

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jfertig25700@northwell.direct-ci.com
• Direct secure messaging: jfertig@northwellhealth.intellechartdirect.net

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.

• North Shore-Lij Medical PC

  dba NHPP Cardiology at Great Neck

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment Care Compare group NPD
• Lens Express Optical, Inc

  • Eyewear Supplier
  • Kew Gardens, NY
  • NPI 1942444914
  Medicare reassignment NPD
• Myeyedr Optometry of Florida, LLC

  dba MyEyeDr.

  • Optometrist
  • Tallahassee, FL
  • NPI 1073907028
  Medicare reassignment NPD
• Myeyedr Optometry of Virginia PLLC

  dba MyEyeDr

  • Optometrist
  • Ashburn, VA
  • NPI 1174933691
  Medicare reassignment NPD
• North Shore - Lij Medical PC

  dba NSLIJ Medical In Queens

  • Internal Medicine Physician
  • New Hyde Park, NY
  • NPI 1790043479
  NPD
• Myeyedr Optometry of Florida, LLC

  • Optometrist
  • Clearwater, FL
  • NPI 1730054594
  NPD
• Myeyedr Optometry of Virginia, PLLC

  dba MyEyeDr.

  • Optometrist
  • Yorktown, VA
  • NPI 1710533963
  NPD
• Myeyedr Optometry of Virginia, PLLC

  • Optometrist
  • North Chesterfield, VA
  • NPI 1932075983
  NPD
• Myeyedr. Optometry of Florida, LLC

  dba MyEyeDr.

  • Optometrist
  • Kissimmee, FL
  • NPI 1952772998
  NPD

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678060800000",
    "number": "1366557738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12430 QUEENS BLVD",
            "city": "KEW GARDENS",
            "state": "NY",
            "postal_code": "114151501",
            "telephone_number": "718-261-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12430 QUEENS BLVD",
            "city": "KEW GARDENS",
            "state": "NY",
            "postal_code": "114151501",
            "telephone_number": "718-261-2344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERTIG",
        "first_name": "JESSE",
        "middle_name": "JACOB",
        "name_prefix": "Mr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3702-35",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "346002045",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "TPOP68",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "105426",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618002935",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV007355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Lois Lorenzo Fabros
• Kayrene Farmer
• Natella Fazylov, RPH
• Evelyn Lucy Fazylova, PHARMD
• Carlos A Fernandez
• Donald Filimon
• Fine & Goodman DDS
• Mark P Finger, MD
• Rifki Fireworker, MA
• First Choice Diagnostics Radiology PC

• Optometrist in Kew Gardens, NY
• Providers in Kew Gardens, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2023; 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.