DR. JILL A ANDERSON (O.D.) – Optometrist, NPI 1366422735
Optometrist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for DR. JILL A ANDERSON (O.D.)
1123, Berlin Street, Waupaca, Waupaca County, Wisconsin, 54981, United States
WAUPACA, WI 549811920
Phone: (715) 340-0496
Type: Mailing
Sam's Club, 1000, North Westhill Boulevard, Appleton, Outagamie County, Wisconsin, 54914, United States
OPTICAL
APPLETON, WI 549145792
Phone: (920) 733-7804
Fax: (920) 733-7940
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $101.
Total Amount is formed as General ($101) + Research ($0) + Ownership ($0) = $101.
Last reported payment date: 2023-10-05 • Largest payer in this snapshot: Johnson & Johnson Vision Care, Inc. ($101).
Total Amount
$101
General + Research + Ownership
Payments
3
Total payment records
General Amount
$101
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-10-05
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Johnson & Johnson Vision Care, Inc. | $101 |
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: 2022-10-28
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20050523001125 | I | Optometry | WI | TBD |
| I20221028000281 | I | Optometry | NC | 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 | 84 | 84 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 18 | 12 | $0 |
Insurance plans in this area (ZIP 54981)
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