Jeremy James Brodersen, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2181 Issued in IA

Practice address

3539 Southern Hills Dr
Sioux City, IA 51106-4750

Phone

(712) 276-2323

Fax

(712) 274-9986

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IA

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, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Shopko Stores Operating Co. LLC

  dba ShopKo Optical 060

  • Eyewear Supplier
  • Albert Lea, MN
  • NPI 1528010642
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477664902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 WALDEN AVE",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511064618",
            "telephone_number": "712-276-2415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3539 SOUTHERN HILLS DR",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511064750",
            "telephone_number": "712-276-2323",
            "fax_number": "712-274-9986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERSEN",
        "first_name": "JEREMY",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "2181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1289819",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica G Brewer
• Dawn M Bricker, FNP
• Ronald William Brinck, M.D.
• Juliet Emerald Brinkman, ARNP
• Thomas Brockhaus, CRNA
• Daniel Louis Brodkey, O.D.
• Austyn Brouillette, LMSW
• Cynthia Brown
• Kallee Louann Brown
• Kemi Regina Brown, LMSW

• Optometrist in Sioux City, IA
• Providers in Sioux City, IA by specialty
• Optometrist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.