Individual provider Active NPI

Jacqueline A Rheault, OD

  • Optometrist
  • Concord, NH
National Provider Identifier
1578564464
Registry record updated Apr 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0646 Issued in NH
Practice address
248 Pleasant St
Ste 1600
Concord, NH 03301-2588
Phone
(603) 224-2020
Fax
(603) 228-0248
NPI assigned
Aug 2, 2005
Last updated
Apr 21, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 0646 NH Primary

Addresses

Primary practice location

248 Pleasant St
Ste 1600
Concord, NH 03301-2588

Mailing address

248 Pleasant St
Ste 1600
Concord, NH 03301-2588
Phone (603) 224-2020

Other identifiers 4

IdentifierTypeStateIssuer
0900169YONH01OtherNHANTHEM
30010905MedicaidNH
410038181OtherMEDICARE RR
312992OtherNHCIGNA

Other names 1

  • Jacqueline R Lipsy Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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
I20051208000758 NH Practitioner - Optometry 3072534841 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2 Pillsbury St
Concord, NH 03301-3549
Phone (603) 224-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0646NHMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Concord Ophthalmologic Associates PA CurrentSince Jul 1, 2014 Accepting new patients
Concord Ophthalmologic Associates PA Optometrist CurrentSince Jul 1, 2014 Accepting new patients

Locations

2 Pillsbury St
Ste 100
Concord, NH 03301
Phone (603) 224-2020

248 Pleasant St
Ste 1600
Concord, NH 03301
Phone (603) 224-2020

Interoperability endpoints

  • Direct secure messaging: jrheault@concord.intellechartdirect.net

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, 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": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587427200000",
    "number": "1578564464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "248 PLEASANT ST",
            "address_2": "STE 1600",
            "city": "CONCORD",
            "state": "NH",
            "postal_code": "033012588",
            "telephone_number": "603-224-2020",
            "fax_number": "603-228-0248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "248 PLEASANT ST",
            "address_2": "STE 1600",
            "city": "CONCORD",
            "state": "NH",
            "postal_code": "033012588",
            "telephone_number": "603-224-2020",
            "fax_number": "603-228-0248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RHEAULT",
        "first_name": "JACQUELINE",
        "middle_name": "A",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-02",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NH",
            "license": "0646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "0900169YONH01",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30010905",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "410038181",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "312992",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "LIPSY",
            "middle_name": "R",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Concord, NH

Sources for this page

Verify at the official NPI Registry.