Juliana Kay Derksen, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT.005201 Issued in OH

Practice address

2468 Dayton Xenia Rd
Beavercreek, OH 45434-7168

Phone

(937) 426-7787

NPI assigned

May 15, 2007

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

Other names 1

• Juliana Kay Chatterjee Former name

Medicare fee-for-service enrollment

Enrolled in OH

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, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aeg Ohio Professional PCGroup PAC ID 7618207036, 80 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Aeg Ohio Professional PC

  • Optometrist
  • Solon, OH
  • NPI 1154980811
  Medicare reassignment Care Compare group NPD
• Aeg Ohio Professional PC

  • Optometrist
  • Cincinnati, OH
  • NPI 1932708047
  NPD

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621036800000",
    "number": "1376759266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 CURTWOOD DR",
            "city": "TIPP CITY",
            "state": "OH",
            "postal_code": "453712710",
            "telephone_number": "609-508-3974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2468 DAYTON XENIA RD",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454347168",
            "telephone_number": "937-426-7787"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1024 N Plum St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "OH",
            "postal_code": "455042108",
            "country_code": "US",
            "telephone_number": "937-342-1988",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "839 US Highway 130",
            "address_purpose": "LOCATION",
            "city": "East Windsor",
            "state": "NJ",
            "postal_code": "085202907",
            "country_code": "US",
            "telephone_number": "609-443-6484",
            "fax_number": "609-443-6492",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERKSEN",
        "first_name": "JULIANA",
        "middle_name": "KAY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-15",
        "last_updated": "2021-05-15",
        "certification_date": "2021-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "OPT.005201",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00601500",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JULIANA",
            "last_name": "CHATTERJEE",
            "middle_name": "KAY",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Optometrist in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2021; 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.