Individual provider Active NPI

Jeffrey A Huettemann, OPTOMETRIST

  • Optometrist
  • Normal, IL
National Provider Identifier
1679644496
Registry record updated Jun 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
46-008558 Issued in IL
Practice address
1607 Visa Dr
Suite 4
Normal, IL 61761-2137
Phone
(309) 454-2472
Fax
(309) 454-3029
NPI assigned
Nov 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 46-008558 IL Primary

Addresses

Primary practice location

1607 Visa Dr
Suite 4
Normal, IL 61761-2137

Mailing address

1607 Visa Dr
Suite 4
Normal, IL 61761-2137
Phone (309) 454-2472

Other identifiers 1

IdentifierTypeStateIssuer
046008558MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20110629000677 IL Practitioner - Optometry 7618155458 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Visionpoint Eye Center LLCGroup PAC ID 0749522092, 15 clinicians

Practice addresses (Care Compare)

1107 Airport Rd
Bloomington, IL 61704-2544
Phone (309) 662-7700

Merit-based Incentive Payment System (MIPS)

Final score
91.11 of 100Reported as group
Quality
97.66
Improvement activities
40
Cost
73.49

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
46-008558ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Visionpoint Eye Center LLC Optometrist CurrentSince Jun 15, 2019 Accepting new patients

Locations

1107 Airport Rd
Bloomington, IL 61704
Phone (309) 662-7700

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212710400000",
    "number": "1679644496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1607 VISA DR",
            "address_2": "SUITE 4",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617612137",
            "telephone_number": "309-454-2472",
            "fax_number": "309-454-3029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1607 VISA DR",
            "address_2": "SUITE 4",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617612137",
            "telephone_number": "309-454-2472",
            "fax_number": "309-454-3029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUETTEMANN",
        "first_name": "JEFFREY",
        "middle_name": "A",
        "credential": "OPTOMETRIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2008-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "46-008558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046008558",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Normal, IL

Sources for this page

Verify at the official NPI Registry.