Individual provider Active NPI

Carlton Robert Fenzl, M.D.

  • Ophthalmology Physician
  • Bettendorf, IA
National Provider Identifier
1386958064
Registry record updated Mar 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
42474 Issued in IA
Practice address
777 Tanglefoot LN
Bettendorf, IA 52722-1650
Phone
(563) 323-2020
Fax
(563) 459-6615
NPI assigned
Aug 4, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 036.137712 IL
Cornea and External Diseases Specialist Physician 207WX0120X 42474 IA
Cornea and External Diseases Specialist Physician 207WX0120X 036.137712 IL
Ophthalmology Physician 207W00000X 42474 IA Primary

Addresses

Primary practice location

777 Tanglefoot LN
Bettendorf, IA 52722-1650

Mailing address

777 Tanglefoot LN
Bettendorf, IA 52722-1650
Phone (563) 323-2020

Other practice location 1

4731 45th Street Ct
Rock Island, IL 61201-7102
Phone (309) 793-2020

Other identifiers 2

IdentifierTypeStateIssuer
1386958064MedicaidIA
036137712MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150605002568 IL Practitioner - Ophthalmology 4880818343 Reassigns benefits to 1 organization
I20150813010785 IA Practitioner - Ophthalmology 4880818343 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Surgeons Associates PCGroup PAC ID 4183521206, 19 clinicians

Practice addresses (Care Compare)

4731 45TH St CT
Rock Island, IL 61201-7102
Phone (309) 793-2020

777 Tanglefoot LN
Bettendorf, IA 52722-1650
Phone (563) 323-2020

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.56 of 100Reported as group
Quality
97.61
Promoting interoperability
98
Improvement activities
40
Cost
32.58

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery707
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
42474IAMDOphthalmology Physician
036.137712ILMDCornea and External Diseases Specialist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Surgeons Associates PC Ophthalmology CurrentSince Aug 3, 2015 Accepting new patients
Eye Surgeons Associates PC Ophthalmology PastSince Aug 3, 2015 Accepting new patients

Locations

777 Tanglefoot Ln
Bettendorf, IA 52722
Phone (319) 323-8888

422 S State St
Geneseo, IL 61254
Phone (309) 944-4608

2570 24th St
Ste 124
Rock Island, IL 61201
Phone (309) 779-3670

4731 45th Street Ct
Rock Island, IL 61201
Phone (309) 793-2020

Interoperability endpoints

  • Direct secure messaging: carlton.fenzl.p2@direct.urologyqc.nextgenshare.com
  • Direct secure messaging: carlton.fenzlmd.p1@direct.esaeyecare.nextgenshare.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1280880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1386958064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 TANGLEFOOT LN",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527221650",
            "telephone_number": "563-323-2020",
            "fax_number": "563-459-6615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 TANGLEFOOT LN",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527221650",
            "telephone_number": "563-323-2020",
            "fax_number": "563-459-6615"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4731 45th Street Ct",
            "address_purpose": "LOCATION",
            "city": "Rock Island",
            "state": "IL",
            "postal_code": "612017102",
            "country_code": "US",
            "telephone_number": "309-793-2020",
            "fax_number": "309-793-2602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FENZL",
        "first_name": "CARLTON",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-04",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036.137712",
            "primary": false
        },
        {
            "code": "207WX0120X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Cornea and External Diseases Specialist",
            "state": "IA",
            "license": "42474",
            "primary": false
        },
        {
            "code": "207WX0120X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Cornea and External Diseases Specialist",
            "state": "IL",
            "license": "036.137712",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IA",
            "license": "42474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386958064",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036137712",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bettendorf, IA

Sources for this page

Verify at the official NPI Registry.