DR. SHANE JENSEN (O.D.) – Optometrist, NPI 1154422822
Optometrist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
312 OPTOMETRY in UT
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Provider Addresses for DR. SHANE JENSEN (O.D.)
P.O. BOX 592
PANGUITCH, UT 84759
Phone: (435) 676-2761
Type: Mailing
Southern Utah Vision Care, 415 E, Center Street, Panguitch, Garfield County, Utah, 84759, United States
PANGUITCH, UT 84759
Phone: (435) 676-8646
Fax: (435) 676-8646
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 $14.
Total Amount is formed as General ($14) + Research ($0) + Ownership ($0) = $14.
Last reported payment date: 2024-01-31 • Largest payer in this snapshot: ABBVIE INC. ($14).
Total Amount
$14
General + Research + Ownership
Payments
1
Total payment records
General Amount
$14
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-01-31
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $14 |
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: 2004-01-17
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 |
|---|---|---|---|---|
| I20040117000211 | I | Optometry | UT | 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 | 798 | 685 | $0 |
| 92012 | Established patient problem focused exam of visual system | 180 | 89 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 104 | 104 | $0 |
| 92250 | Photography of the retina | 91 | 84 | $0 |
| 92083 | Exam of visual field with extended testing | 17 | 17 | $0 |
Insurance plans in this area (ZIP 84759)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| OPTOMETRY | UT | 92134 | Diagnostic imaging of retina | 38 | 37 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | CO | |
| O P H T H A L M O L O G Y | NM | |
| O P H T H A L M O L O G Y | UT |
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