Jenna Derubeis, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT-002424 Issued in AZ

Practice address

16515 S 40TH St Ste 111
Phoenix, AZ 85048-0559

Phone

(480) 706-2020

NPI assigned

Jun 2, 2020

Last updated

Oct 9, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ

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

Illinois College of Optometry at Chicago, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Primary Eye Care Center of Ahwatukee PLCGroup PAC ID 1153732078, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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

• Primary Eye Care Center of Ahwatukee, PLC

  • Optometrist
  • Phoenix, AZ
  • NPI 1477166379
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1591056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1447874755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3911 W BUIST AVE",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853391251",
            "telephone_number": "480-330-1162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16515 S 40TH ST STE 111",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850480559",
            "telephone_number": "480-706-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERUBEIS",
        "first_name": "JENNA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-02",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "OPT-002424",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "AZ",
            "license": "OPT-002424",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "AZ",
            "license": "OPT-002424",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.primaryeyecenter.com/",
            "affiliation": "N",
            "endpointDescription": "Office Website",
            "address_1": "16515 S 40th St Ste 111",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850480559",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cheri Diane Dersam, M.D.
• Michael D Dersam, MD
• Anne Merrylees Dersch, MD
• Michael H Dershowitz, DPM
• Shockie M Dersno, LPC
• Ina Dervishi, MD
• Juniper Dery-Chaffin, PA-C
• Anish Kumar Desai, MD
• Dev M. Desai, M.D.
• Nima Manish Desai, M.D.

• Optometrist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Optometrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; 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.