Individual provider Active NPI

Emily S Richardson, O.D.

  • Optometrist
  • Dixon, IL
National Provider Identifier
1750761458
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046.010863 Issued in IL
Practice address
511 Palmyra St
Dixon, IL 61021
Phone
(815) 284-2020
NPI assigned
Jun 8, 2015
Last updated
Nov 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046.010863 IL Primary

Addresses

Primary practice location

511 Palmyra St
Dixon, IL 61021

Mailing address

511 Palmyra St
Dixon, IL 61021-1953
Phone (815) 284-2020

Other identifiers 2

IdentifierTypeStateIssuer
046010863MedicaidIL
F400221463OtherILMEDICARE

Other names 1

  • Dr. Emily S Sorenson Former name

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
I20150622002139 IL Practitioner - Optometry 5294046975 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

511 Palmyra St
Dixon, IL 61021-1953
Phone (815) 284-2020

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.78 of 100Reported as group
Quality
60.49
Promoting interoperability
100
Improvement activities
40
Cost
77.11

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery19

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046.010863ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
KSB Medical Group, Inc. Current Accepting new patients
KSB Medical Group, Inc. CurrentSince Jul 1, 2015 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
KSB Medical Group, Inc. CurrentSince Jul 1, 2015 Accepting new patients
Osf Multi-Specialty Group CurrentSince Dec 17, 2024 Accepting new patients

Locations

215 E 1st St
Ste 111
Dixon, IL 61021
Phone (815) 285-5477

215 E 1st St
Ste 117
Dixon, IL 61021
Phone (815) 285-5900

511 Palmyra St
Dixon, IL 61021
Phone (815) 284-2020

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

Interoperability endpoints

  • Direct secure messaging: erichardson19919@cghmc.direct-ci.com

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1433721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1750761458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 PALMYRA ST",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610211953",
            "telephone_number": "815-284-2020",
            "fax_number": "815-284-8326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 PALMYRA ST",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "61021",
            "telephone_number": "815-284-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "EMILY",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-08",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.010863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046010863",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "F400221463",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMILY",
            "last_name": "SORENSON",
            "middle_name": "S",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dixon, IL

Sources for this page

Verify at the official NPI Registry.