Karsen Hise Maxwell, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

126421 Issued in IA

Practice address

777 Tanglefoot LN
Bettendorf, IA 52722-1650

Phone

(563) 323-2020

Fax

(563) 328-5699

NPI assigned

Jun 22, 2023

Last updated

Sep 23, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Karsen Tayler Hise Former name

Medicare fee-for-service enrollment

Enrolled in TX, IA, IL3 enrollments

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 3

Specialty

Optometry

Education

University of Houston - College of Optometry, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Surgeons Associates PCGroup PAC ID 4183521206, 19 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Genesis HLTH System Dba Genesis MDL Ctr-Illini Hospital, Silvis, IL, CCN 140275

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: karsen.maxwellod.p1@direct.esaeyecare.nextgenshare.com

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.

• Eye Surgeons Associates PC

  • Ophthalmology Physician
  • Bettendorf, IA
  • NPI 1386607562

  IL, Optometrist

  Medicare reassignment Care Compare group NPD
• University of Houston System

  dba University Eye Institute

  • Optometrist
  • Houston, TX
  • NPI 1861493140
  Medicare reassignment NPD
• University of Houston

  • Community Health Worker
  • Houston, TX
  • NPI 1366081622
  NPD
• University of Houston System

  • Speech-Language Pathologist
  • Houston, TX
  • NPI 1447371430
  NPD
• Eye Surgeons Associates PC

  • Eyewear Supplier
  • Rock Island, IL
  • NPI 1316030034

  Optometrist

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Genesis Health System

  dba Genesis Medical Center - Silvis

  • General Acute Care Hospital
  • Silvis, IL
  • NPI 1427132604
  Care Compare affiliation

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

{
    "created_epoch": "1687392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727049600000",
    "number": "1619653995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 TANGLEFOOT LN",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527221650",
            "telephone_number": "563-323-2020",
            "fax_number": "563-328-5699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 TANGLEFOOT LN",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527221650",
            "telephone_number": "563-323-2020",
            "fax_number": "563-328-5699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "KARSEN",
        "middle_name": "HISE",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-22",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "126421",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.011915",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS STATE MEDICAL BOARD",
            "identifier": "046.011915",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA STATE MEDICAL BOARD",
            "identifier": "126421",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS OPTOMETRY BOARD",
            "identifier": "10901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KARSEN",
            "last_name": "HISE",
            "middle_name": "TAYLER",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Optometrist in Bettendorf, IA
• Providers in Bettendorf, IA by specialty
• Optometrist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; 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.