Organization Active NPI

Eyecare of Ankeny

  • Optometrist
  • Ankeny, IA
National Provider Identifier
1700593597
Registry record updated Nov 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
EYECARE OF ANKENY
Practice address
111 NW 9TH St
Ankeny, IA 50023-1754
Phone
(515) 964-7355
Fax
(515) 964-8413
NPI assigned
Nov 1, 2022
Last updated
Nov 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2022

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

Authorized official

Name
Mrs. Janae L Jelsma
Title
Practice Manager
Phone
(515) 964-7355

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

111 NW 9TH St
Ankeny, IA 50023-1754

Mailing address

111 NW 9TH St
Ankeny, IA 50023-1754
Phone (515) 964-7355

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address jordan.ukena@direct.revolutionehr.com Health Information Exchange (HIE)
Direct Messaging Address James.Schroder@direct.revolutionehr.com Health Information Exchange (HIE)
Direct Messaging Address James.Schroder@direct.revolutionehr.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230119000348 IA Part B Supplier - Clinic/Group Practice 3476924010 Receives reassigned benefits from 2 practitioners
Practice locations: Ankeny, IA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2067462Eyecare Associates of Ankeny111 NW 9TH Street, Ankeny, IA 50023Certificate of waiverOct 15, 2027

National Provider Directory

National Provider Directory

Locations

111 NW 9th St
Ankeny, IA 50023
Phone (515) 964-7355

Interoperability endpoints

  • Direct secure messaging: james.schroder@direct.revolutionehr.com

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1667260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667260800000",
    "number": "1700593597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 NW 9TH ST",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500231754",
            "telephone_number": "515-964-7355",
            "fax_number": "515-964-8413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 NW 9TH ST",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500231754",
            "telephone_number": "515-964-7355",
            "fax_number": "515-964-8413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARE OF ANKENY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-01",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "status": "A",
        "authorized_official_last_name": "JELSMA",
        "authorized_official_first_name": "JANAE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "515-964-7355",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jordan.ukena@direct.revolutionehr.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "111 NW 9th St",
            "city": "Ankeny",
            "state": "IA",
            "country_code": "US",
            "postal_code": "500231754",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "James.Schroder@direct.revolutionehr.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "111 NW 9th St",
            "city": "Ankeny",
            "state": "IA",
            "country_code": "US",
            "postal_code": "500231754",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "James.Schroder@direct.revolutionehr.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "111 NW 9th St",
            "city": "Ankeny",
            "state": "IA",
            "country_code": "US",
            "postal_code": "500231754",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Ankeny, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.