Jenna Lelsey Sullivan, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3564-35 Issued in WI

Practice address

1 Bank Ave
Kaukauna, WI 54130-2581

Phone

(920) 766-2481

NPI assigned

Jun 18, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

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, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Magiera Eyecare LLCGroup PAC ID 6406950690, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ocuco_greenvilleeyecare

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.

• Magiera Eyecare LLC.

  • Optometrist
  • Kaukauna, WI
  • NPI 1831636828
  Medicare reassignment Care Compare group
• Greenville Eyecare LLC

  • Optometrist
  • Greenville, WI
  • NPI 1518245703
  NPD
• Magiera Eyecare LLC

  • Optometrist
  • Kaukauna, WI
  • NPI 1154456093
  NPD (past)

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

{
    "created_epoch": "1529280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562025600000",
    "number": "1366936932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2331 WILLOW DROP WAY",
            "city": "OVIEDO",
            "state": "FL",
            "postal_code": "327667083",
            "telephone_number": "732-684-2761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BANK AVE",
            "city": "KAUKAUNA",
            "state": "WI",
            "postal_code": "541302581",
            "telephone_number": "920-766-2481"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "N1739 Lily Of The Valley Dr Ste 2",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "WI",
            "postal_code": "549429104",
            "country_code": "US",
            "telephone_number": "920-560-3937",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JENNA",
        "middle_name": "LELSEY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-18",
        "last_updated": "2019-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3564-35",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC5544",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St. Paul Elder Services
• Whitney Stager, LMFT
• Amy Kathryn Steinbach, LPN
• Jennifer Lynn Stelow, PTA
• Stone Chiropractic, LLC
• Sunrise Care Homes
• Karen Teutschmann
• Gaosheng Thao
• The Doc at Your Door,LLC
• Kasey Trunk

• Optometrist in Kaukauna, WI
• Providers in Kaukauna, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2019; 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.