Individual provider Active NPI

Jonathan F Shaver, O.D.

  • Optometrist
  • Fayetteville, AR
National Provider Identifier
1790764454
Registry record updated Sep 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2549 Issued in AR
Practice address
594 E Millsap
Fayetteville, AR 72703-1345
Phone
(479) 442-2020
Fax
(479) 521-3988
NPI assigned
Jan 11, 2006
Last updated
Sep 11, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2012

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2549 AR Primary
Optometrist 152W00000X 558 NM
Corneal and Contact Management Optometrist 152WC0802X 2549 AR
Pediatric Optometrist 152WP0200X 2549 AR

Addresses

Primary practice location

594 E Millsap
Fayetteville, AR 72703-1345

Mailing address

594 E Millsap
Fayetteville, AR 72703-2801
Phone (479) 442-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20050812000406 AR Practitioner - Optometry 1850342593 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Center PAGroup PAC ID 5395713382, 8 clinicians

Practice addresses (Care Compare)

594 E Millsap Rd
Fayetteville, AR 72703-4096
Phone 4794422020107

Merit-based Incentive Payment System (MIPS)

Final score
90.36 of 100Reported as group
Quality
93.44
Improvement activities
40
Cost
76.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
558NMMDRegistered Dietitian
2549ARMDCorneal and Contact Management Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Center, PA Optometrist CurrentSince Apr 30, 2007 Accepting new patients
Eye Deal Vision P.C. Optometrist PastSince Sep 1, 1999 Accepting new patients
Jonathan F. Shaver, O.D. Optometrist PastSince Jul 12, 2013 Accepting new patients

Locations

594 E Millsap Rd
Fayetteville, AR 72703
Phone (479) 442-2020

Interoperability endpoints

  • Direct secure messaging: jshaver@eyecenternwa.emadirect.md

Organizations & group practices 3

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": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347321600000",
    "number": "1790764454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "594 E MILLSAP",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727032801",
            "telephone_number": "479-442-2020",
            "fax_number": "479-521-3988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "594 E MILLSAP",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727031345",
            "telephone_number": "479-442-2020",
            "fax_number": "479-521-3988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAVER",
        "first_name": "JONATHAN",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-11",
        "last_updated": "2012-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2549",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NM",
            "license": "558",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "AR",
            "license": "2549",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "AR",
            "license": "2549",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.