DR. DEREK P. JACOBSEN – Optometrist, NPI 1124462593
Optometrist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
847 OPTOMETRY in AZ
Provider Addresses for DR. DEREK P. JACOBSEN
18325 N ALLIED WAY
SUITE 100
PHOENIX, AZ 850543105
Phone: (602) 467-4966
Fax: (480) 419-5401
Type: Mailing
14269 N 87TH ST STE 203
SCOTTSDALE, AZ 852603695
Phone: (480) 483-8882
Fax: (480) 419-5401
Type: Mailing
13613 W CAMINO DEL SOL STE 2
SUN CITY WEST, AZ 853754480
Phone: (623) 584-2100
Fax: (623) 584-0023
Type: Location
7727 W Deer Valley Rd Ste E200
Peoria, AZ 853822114
Phone: (623) 376-9070
Type: Location
18325 N Allied Way
Suite 100
Phoenix, AZ 850543105
Phone: (602) 467-4966
Fax: (480) 419-5401
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 38 Open Payments records for all available years, with a total value of $2,845.
Total Amount is formed as General ($2,845) + Research ($0) + Ownership ($0) = $2,845.
Last reported payment date: 2024-12-24 • Largest payer in this snapshot: RxSight Inc ($1,500).
Total Amount
$2,845
General + Research + Ownership
Payments
38
Total payment records
General Amount
$2,845
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-24
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| RxSight Inc | $1,500 |
| Bausch & Lomb Americas Inc. | $446 |
| BIOTISSUE HOLDINGS INC. | $179 |
| BIOTISSUE HOLDINGS, INC. | $165 |
| CooperVision Inc. | $115 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2014-10-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20141002002166 | I | Optometry | AZ | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 92014 | Established patient complete exam of visual system | 370 | 340 | $0 |
| 92134 | Imaging of retina | 195 | 176 | $0 |
| 92004 | New patient complete exam of visual system | 78 | 78 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 64 | 61 | $0 |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 56 | 54 | $0 |
Insurance plans in this area (ZIP 85054)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| O P T O M E T R Y | AZ | |
| O P T O M E T R Y | AZ | |
| O P H T H A L M O L O G Y | IN | |
| O P H T H A L M O L O G Y | TX | |
| O P H T H A L M O L O G Y | AZ | |
| O P H T H A L M O L O G Y | AZ | |
| O P H T H A L M O L O G Y | TX | |
| O P H T H A L M O L O G Y | TX | |
| O P T O M E T R Y | FL | |
| - | FL |
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