John Mark Deboer, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

18002449 Issued in IN

Practice address

609 N Halleck St
Demotte, IN 46310-9545

Phone

(219) 987-3673

Fax

(219) 987-3905

NPI assigned

Nov 25, 2005

Last updated

Sep 2, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aeg Indiana Professional PCGroup PAC ID 2365826179, 30 clinicians

Deboer OD LTDGroup PAC ID 2860421922, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Aeg Indiana Professional PC

  • Optometrist
  • Warsaw, IN
  • NPI 1043944127
  Medicare reassignment Care Compare group NPD
• Deboer OD LTD

  dba DeBoer Family Eyecare

  • Optometrist
  • Demotte, IN
  • NPI 1972513653
  Medicare reassignment Care Compare group
• De Boer OD., LTD

  dba De Boer Family Eyecare

  • Optometrist
  • Demotte, IN
  • NPI 1841307329
  Authorized official Same address or phone
• Dr Tabitha G Temple PC

  • Optometrist
  • Warsaw, IN
  • NPI 1851484125
  NPD (past)

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

{
    "created_epoch": "1132876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283385600000",
    "number": "1770566556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 849",
            "city": "DEMOTTE",
            "state": "IN",
            "postal_code": "463100849",
            "telephone_number": "219-987-3673",
            "fax_number": "219-987-3905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 N HALLECK ST",
            "city": "DEMOTTE",
            "state": "IN",
            "postal_code": "463109545",
            "telephone_number": "219-987-3673",
            "fax_number": "219-987-3905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEBOER",
        "first_name": "JOHN",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-25",
        "last_updated": "2010-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002449",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-008335",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200395230",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "K48802",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sydney Nicole Cox
• Creative Spirit Counseling LLC
• Crestmark of Roselawn
• De Boer OD., LTD (De Boer Family Eyecare)
• Deboer OD LTD (DeBoer Family Eyecare)
• Kevin John Defries, D.C.
• Demotte Physicians Inc.
• Gerrit H. Devries, O.D.
• Judy C Dewitt
• Carman Lashawn Dobbins

• Optometrist in Demotte, IN
• Providers in Demotte, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2010; 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.