Jackelleyn Renee Mudd, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2017017079 Issued in MO

Practice address

1310 S Business 61
Bowling Green, MO 63334-5221

Phone

(573) 324-3131

NPI assigned

Jun 5, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

Indiana University - School of Optometry, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Eyecare of Winfield LLCGroup PAC ID 5799861639, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Advanced Eyecare of Winfield LLC

  • Optometrist
  • Winfield, MO
  • NPI 1053599472
  Medicare reassignment Care Compare group NPD
• Denise M Harvey, OD

  • Optometrist
  • Bowling Green, MO
  • NPI 1265473383
  Medicare reassignment
• Advanced Eye Care of Winfield LLC

  dba Advanced Eye Care

  • Optometrist
  • Troy, MO
  • NPI 1013143957
  NPD
• Denise M. Harvey Dba Advanced Eyecare

  dba Bowling Green Eyecare LLC

  • Optometrist
  • Bowling Green, MO
  • NPI 1356367981
  NPD

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

{
    "created_epoch": "1496620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1609305580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4366 HIGHWAY H",
            "city": "SILEX",
            "state": "MO",
            "postal_code": "633772256",
            "telephone_number": "636-485-7788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 S BUSINESS 61",
            "city": "BOWLING GREEN",
            "state": "MO",
            "postal_code": "633345221",
            "telephone_number": "573-324-3131"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "102 Eagles Bluff Hts",
            "address_purpose": "LOCATION",
            "city": "Winfield",
            "state": "MO",
            "postal_code": "633893453",
            "country_code": "US",
            "telephone_number": "636-668-6171",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "43 Ellis Ave",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "MO",
            "postal_code": "633791151",
            "country_code": "US",
            "telephone_number": "636-528-4144",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUDD",
        "first_name": "JACKELLEYN",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-05",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2017017079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Bowling Green, MO
• Providers in Bowling Green, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.