JACKSON CADE SHETLAR (OD) – Optometrist, NPI 1205674389

JACKSON CADE SHETLAR (OD) is a healthcare provider. based in Minneapolis, Kansas. specializing in OPTOMETRY. They hold the professional credentials OD. They hold a License No. 2231 (KS). The NPI Number for JACKSON CADE SHETLAR (OD) is 1205674389

Main info

Male
2 Years Of Experience
Accepts Medicare Assignment
Name
JACKSON CADE SHETLAR (OD)
NPI
1205674389
Phone
(785) 392-2126
Address
407 W 2nd St
Enumeration Date
15 July 2024
Last Update Date
18 July 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7858254679
Graduation Year
2024 (2 years ago)
PAC ID
1557809233
Group Practice PAC ID
7416840392
Professional Enrollment ID
I20240813001194
Address ID
KS674013237SA1601XAVEX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience26
Completeness75
Years active:1State licenses:1Digital endpointsOther names

532 OPTOMETRY in KS

Provider Addresses for JACKSON CADE SHETLAR (OD)

  • 407 W 2nd St

    Minneapolis, KS 674672315

    Phone: (785) 392-2126

    Fax: (785) 392-2180

    Type: Location

  • 1601 E IRON AVE

    SALINA, KS 674013237

    Phone: (785) 825-4679

    Fax: (785) 825-5898

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $129.

Total Amount is formed as General ($129) + Research ($0) + Ownership ($0) = $129.

Last reported payment date: 2024-09-24 • Largest payer in this snapshot: Genentech USA, Inc. ($129).

Total Amount

$129

General + Research + Ownership

Payments

1

Total payment records

General Amount

$129

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-09-24

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Genentech USA, Inc.$129
View all Open Payments →|Open Payments Risk Radar →

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: 2024-08-13

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240813001194IOptometryKSTBD

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.

Verify on CMS Revalidation Lookup Tool

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 67467)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 7416840392View full group profile
NameSpecialtyState
O P T O M E T R YKS
O P T O M E T R YKS
O P T O M E T R YKS

Reviews

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Frequently asked questions

Does JACKSON CADE SHETLAR (OD) have a public NPI I can cite?
Public records show JACKSON CADE SHETLAR (OD) under NPI 1205674389.
Should I treat JACKSON CADE SHETLAR (OD) as an active provider?
Patients and plans typically see JACKSON CADE SHETLAR (OD) as active in the national extract.
How should patients interpret JACKSON CADE SHETLAR (OD)'s specialty?
The extract shows Optometrist for JACKSON CADE SHETLAR (OD). Clinical services aligned with this taxonomy classification.
Is JACKSON CADE SHETLAR (OD) tied to Minneapolis, Kansas?
If you are local to Minneapolis, Kansas, JACKSON CADE SHETLAR (OD) may be relevant to your search.
Who maintains JACKSON CADE SHETLAR (OD)'s record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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