Individual provider Active NPI

Jenny Xu

  • Optometrist
  • Lafayette, IN
National Provider Identifier
1558620831
Registry record updated Aug 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18004349A Issued in IN
Practice address
1221 S Creasy LN Ste a
Lafayette, IN 47905-7430
Phone
(165) 447-4951
NPI assigned
May 8, 2012
Last updated
Aug 26, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Optometrist 152W00000X 18004349A IN Primary

Addresses

Primary practice location

1221 S Creasy LN Ste a
Lafayette, IN 47905-7430

Mailing address

1063 Mangrove LN
Alameda, CA 94502-7009
Phone (909) 576-7710

Other practice location 1

928 Colyear Springs Ln
Walnut, CA 91789-4120
Phone (909) 576-7710

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20220819002148 IN Practitioner - Optometry 2163718032 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Evans Eye Care IncGroup PAC ID 9830169234, 33 clinicians

Practice addresses (Care Compare)

1221 S Creasy LN
Suite a
Lafayette, IN 47905-7430
Phone (765) 447-4951

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18004349AINMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Evans Eye Care Inc Optometrist CurrentSince Oct 1, 2022 Accepting new patients

Locations

1221 S Creasy Ln
Ste A
Lafayette, IN 47905
Phone (765) 447-4951

3526 Osborne Ln
Lafayette, IN 47909
Phone (765) 447-4951

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1336435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661472000000",
    "number": "1558620831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1063 MANGROVE LN",
            "city": "ALAMEDA",
            "state": "CA",
            "postal_code": "945027009",
            "telephone_number": "909-576-7710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 S CREASY LN STE A",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479057430",
            "telephone_number": "165-447-4951"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "928 Colyear Springs Ln",
            "address_purpose": "LOCATION",
            "city": "Walnut",
            "state": "CA",
            "postal_code": "917894120",
            "country_code": "US",
            "telephone_number": "909-576-7710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "XU",
        "first_name": "JENNY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-08",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18004349A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "901 Nevin Ave",
            "city": "Richmond",
            "state": "CA",
            "country_code": "US",
            "postal_code": "948013143",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

Verify at the official NPI Registry.