Kylie Hartigan Jacobsen, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3537 Issued in MN

Practice address

19576 Holt St NW
Elk River, MN 55330-1287

Phone

(763) 241-2083

Fax

(763) 241-2083

NPI assigned

Oct 17, 2017

Last updated

Oct 17, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MLP OptometryGroup PAC ID 3870820814, 6 clinicians

Elaine Happ OD PAGroup PAC ID 3375580426, 5 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.

• Elaine Happ OD PA

  dba Uptown Eye Care

  • Optometrist
  • Monticello, MN
  • NPI 1033281597
  Medicare reassignment Care Compare group NPD
• MLP Optometry LTD

  • Optometrist
  • Saint Cloud, MN
  • NPI 1801454608
  Medicare reassignment Care Compare group NPD
• Minnesota Optical LLC

  dba dba Pearle Vision

  • Optometrist
  • Elk River, MN
  • NPI 1831303437
  Medicare reassignment NPD
• Minnesota Optical LLC

  dba Pearle Vision

  • Eyewear Supplier
  • Edina, MN
  • NPI 1962829580
  NPD

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

{
    "created_epoch": "1508198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508198400000",
    "number": "1891206819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19576 HOLT ST NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301287",
            "telephone_number": "763-241-2083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19576 HOLT ST NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301287",
            "telephone_number": "763-241-2083",
            "fax_number": "763-241-2083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "KYLIE",
        "middle_name": "HARTIGAN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-17",
        "last_updated": "2017-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison Elaine Ilstrup, DDS
• Laura Imig, MS, ATC
• Ind School Dist 728
• Integrated Care Service
• Tiffany Marie Jacobs
• Kimberly S Jacobson, OTR/L
• Nicole Elizabeth Janovec
• Erika Christine Januschka, OD
• Anton F Jarmoluk, D.D.S.
• Jeffrey Mark Jarmoluk, D.D.S.

• Optometrist in Elk River, MN
• Providers in Elk River, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2017; 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.