Individual provider Active NPI

Jacqueline A Crow, O.D.

  • Optometrist
  • Peoria, IL
National Provider Identifier
1528298684
Registry record updated Oct 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046010281 Issued in IL
Practice address
8921 N Wood Sage Rd
Peoria, IL 61615-7822
Phone
(309) 243-2400
Fax
(309) 243-7918
NPI assigned
Jul 22, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046010281 IL Primary

Addresses

Primary practice location

8921 N Wood Sage Rd
Peoria, IL 61615-7822

Mailing address

8921 N Wood Sage Rd
Peoria, IL 61615-7822
Phone (309) 243-2400

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Direct@IllinoisEyeCenterPeoriaIL.CompulinkDirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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

Enrollment IDStateProvider typePAC IDDetails
I20090831000279 IL Practitioner - Optometry 3072668854 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wyman Sicher Eye Associates SCGroup PAC ID 7911965801, 20 clinicians

Practice addresses (Care Compare)

8921 N Wood Sage Rd
Peoria, IL 61615-7822
Phone (309) 243-2400

Merit-based Incentive Payment System (MIPS)

Final score
90.67 of 100Reported as group
Quality
95.34
Promoting interoperability
100
Improvement activities
40
Cost
73.56

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046010281ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Wyman Sicher Eye Associates SC Optometrist CurrentSince Jul 5, 2009 Accepting new patients
Wyman Sicher Eye Associates SC CurrentSince Jul 5, 2009 Accepting new patients

Locations

2709 Broadway St
Pekin, IL 61554
Phone (309) 243-2400

8921 N Wood Sage Rd
Peoria, IL 61615
Phone (309) 243-2400

93 Eastgate Dr
Washington, IL 61571
Phone (309) 243-2400

Interoperability endpoints

  • Direct secure messaging: direct@illinoiseyecenterpeoriail.compulinkdirect.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1248220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634688000000",
    "number": "1528298684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8921 N WOOD SAGE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616157822",
            "telephone_number": "309-243-2400",
            "fax_number": "309-243-7918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8921 N WOOD SAGE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616157822",
            "telephone_number": "309-243-2400",
            "fax_number": "309-243-7918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROW",
        "first_name": "JACQUELINE",
        "middle_name": "A",
        "name_prefix": "Miss",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-22",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Direct@IllinoisEyeCenterPeoriaIL.CompulinkDirect.com",
            "affiliation": "N",
            "endpointDescription": "CCD only, does not accept attachments",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "8921 N Wood Sage Rd",
            "city": "Peoria",
            "state": "IL",
            "country_code": "US",
            "postal_code": "616157822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.