DR. DALLAS DUSTIN FITZGERALD (O.D.) – Optometrist, NPI 1396716619
Optometrist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
863 OPTOMETRY in MO
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Provider Addresses for DR. DALLAS DUSTIN FITZGERALD (O.D.)
19738 SUNSET RDG
SAINT JOSEPH, MO 645058560
Phone: (816) 662-9222
Type: Mailing
1605, South Main Street, Maryville, Polk Township, Nodaway County, Missouri, 64468, United States
WAL-MART VISION CENTER
MARYVILLE, MO 644682611
Phone: (660) 562-0215
Fax: (660) 562-0217
Type: Location
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 $87.
Total Amount is formed as General ($87) + Research ($0) + Ownership ($0) = $87.
Last reported payment date: 2024-03-06 • Largest payer in this snapshot: RxSight Inc ($87).
Total Amount
$87
General + Research + Ownership
Payments
1
Total payment records
General Amount
$87
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-03-06
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| RxSight Inc | $87 |
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: 2004-04-19
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 |
|---|---|---|---|---|
| I20040419001667 | I | Optometry | MO | 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 | 119 | 117 | $0 |
| 92004 | New patient complete exam of visual system | 72 | 72 | $0 |
| 92012 | Established patient problem focused exam of visual system | 33 | 32 | $0 |
| 66984 | Removal of cataract with insertion of prosthetic lens | 31 | 18 | $0 |
| 92002 | New patient problem focused exam of visual system | 30 | 30 | $0 |
Insurance plans in this area (ZIP 64505)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| OPTOMETRY | MO | 92012 | Eye and medical examination for diagnosis and treatment, established patient | 21 | 19 |
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