Individual provider Active NPI

Terry J Wolthuis, O.D.

  • Optometrist
  • Spearfish, SD
National Provider Identifier
1770524688
Registry record updated Apr 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
567 Issued in SD
Practice address
1230 North Avenue Suite 3
Spearfish, SD 57783-1572
Phone
(605) 642-4656
Fax
(605) 717-2413
NPI assigned
Jun 10, 2006
Last updated
Apr 14, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X T567 SD
Optometrist 152W00000X 567 SD Primary

Addresses

Primary practice location

1230 North Avenue Suite 3
Spearfish, SD 57783-1572

Mailing address

1230 North Avenue Suite 3
Spearfish, SD 57783-1572
Phone (605) 642-4656

Other identifiers 1

IdentifierTypeStateIssuer
9203223MedicaidSD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
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
I20040205000793 SD Practitioner - Optometry 5193618841 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifetime EyecareGroup PAC ID 7517948011, 2 clinicians

Practice addresses (Care Compare)

1230 N Ave
Suite 3
Spearfish, SD 57783-1572
Phone (605) 642-4656

Merit-based Incentive Payment System (MIPS)

Final score
94.98 of 100Reported as group
Quality
91.42
Promoting interoperability
99
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery79

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
T567SDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Lifetime Eyecare Optometrist CurrentSince May 1, 2021 Accepting new patients

Locations

1230 North Ave
Ste 3
Spearfish, SD 57783
Phone (605) 642-4656

Interoperability endpoints

  • Direct secure messaging: terry.wolthuis@direct.revolutionehr.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649894400000",
    "number": "1770524688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 NORTH AVENUE SUITE 3",
            "city": "SPEARFISH",
            "state": "SD",
            "postal_code": "577831572",
            "telephone_number": "605-642-4656",
            "fax_number": "605-717-2413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 NORTH AVENUE SUITE 3",
            "city": "SPEARFISH",
            "state": "SD",
            "postal_code": "577831572",
            "telephone_number": "605-642-4656",
            "fax_number": "605-717-2413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLTHUIS",
        "first_name": "TERRY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-10",
        "last_updated": "2022-04-14",
        "certification_date": "2022-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SD",
            "license": "T567",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SD",
            "license": "567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9203223",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spearfish, SD

Sources for this page

Verify at the official NPI Registry.