Jacquelyn H Patterson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

18001954A Issued in IN

Practice address

2320 S Tibbs Ave
Indianapolis, IN 46241-4801

Phone

(317) 241-2019

Fax

(317) 487-2182

NPI assigned

Oct 16, 2006

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

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

Indiana University - School of Optometry, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PHB Vision Group, P.C.Group PAC ID 5193200517, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• PHB Vision Group, P.C.

  • Optometrist
  • Fort Wayne, IN
  • NPI 1346105723
  Medicare reassignment Care Compare group NPD
• Wisconsin Vision, Inc

  • Optometrist
  • Avon, IN
  • NPI 1619015716
  NPD
• Wisconsin Vision, LLC

  • Optometrist
  • New Berlin, WI
  • NPI 1134179427
  NPD

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338422400000",
    "number": "1912087909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 ROHN RD",
            "city": "MOORESVILLE",
            "state": "IN",
            "postal_code": "461588073",
            "telephone_number": "317-831-8480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 S TIBBS AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462414801",
            "telephone_number": "317-241-2019",
            "fax_number": "317-487-2182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATTERSON",
        "first_name": "JACQUELYN",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2012-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18001954A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200970100",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTROLLED SUBSTANCE CERTIFICATE",
            "identifier": "18001954B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diana M Patterson, MD
• Elissa M Patterson
• Esme Rose Patterson, DDS
• Ivoryanna J Patterson, MSE
• Jackson Patterson, MSW
• Katherine H Patterson, MD
• Kurt Patterson, MD
• Lequia Patterson
• Lindsay C Patterson, LCSW
• Lora Patterson, LMHC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2012; 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.