Individual provider Active NPI

Lexi Taylor Kortsen, OD

  • Optometrist
  • Flagstaff, AZ
National Provider Identifier
1558987644
Registry record updated May 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT-002429 Issued in AZ
Practice address
900 N San Francisco St
Flagstaff, AZ 86001-3236
Phone
(928) 779-7000
NPI assigned
Jun 24, 2020
Last updated
May 17, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 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 OPT-002429 AZ Primary

Addresses

Primary practice location

900 N San Francisco St
Flagstaff, AZ 86001-3236

Mailing address

1600 W University Ave Ste 105
Flagstaff, AZ 86001-3154
Phone (928) 240-9214

Other practice location 1

1600 W University Ave Ste 105
Flagstaff, AZ 86001-3154
Phone (928) 240-9214

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20200630002930 AZ Practitioner - Optometry 6507289014 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Highline Eye Care, PLLCGroup PAC ID 5395143572, 3 clinicians

Practice addresses (Care Compare)

1600 W University Ave
Suite 105
Flagstaff, AZ 86001-3154
Phone (928) 240-9214

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT-002429AZMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Highline Eye Care, PLLC Optometrist CurrentSince Jun 2, 2021 Accepting new patients
Northern Arizona Optometry, PLLC Optometrist CurrentSince Sep 1, 2020 Accepting new patients
Northern Arizona Eye Associates CurrentSince Jun 1, 2020 Accepting new patients

Locations

1600 W University Ave
Ste 105
Flagstaff, AZ 86001
Phone (928) 240-9214

420 N Humphreys St
Flagstaff, AZ 86001
Phone (928) 774-7949

900 N San Francisco St
Flagstaff, AZ 86001
Phone (928) 779-7000

Interoperability endpoints

  • Direct secure messaging: lexi.kortsen@mahanti.direct.eyemdemr.com

Organizations & group practices 3

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": "1592956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621209600000",
    "number": "1558987644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W UNIVERSITY AVE STE 105",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013154",
            "telephone_number": "928-240-9214",
            "fax_number": "928-240-9212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N SAN FRANCISCO ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013236",
            "telephone_number": "928-779-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 W University Ave Ste 105",
            "address_purpose": "LOCATION",
            "city": "Flagstaff",
            "state": "AZ",
            "postal_code": "860013154",
            "country_code": "US",
            "telephone_number": "928-240-9214",
            "fax_number": "928-240-9212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KORTSEN",
        "first_name": "LEXI",
        "middle_name": "TAYLOR",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-24",
        "last_updated": "2021-05-17",
        "certification_date": "2021-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "OPT-002429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

Verify at the official NPI Registry.