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KENNETH TREVOR SHEALY O.D.
NPI 1104436922
Optometrist in Tifton, GA

Active since August 06, 2020PECOS EnrolledAccepts Medicare Assignment
76.05/100
CMS Quality Rating
1803 OLD OCILLA RD, TIFTON, GA 31794(229) 386-2181(229) 386-2193 Get Directions Write a Review

NPPES record last updated: August 23, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Aug 23, 2024, Aug 6, 2020 (2 updates tracked since 2020).

About Kenneth Trevor Shealy O.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNETH TREVOR SHEALY O.D. (NPI 1104436922) is an individual optometrist in Tifton, Georgia, licensed in Georgia (OPT003252) and active in the NPI registry since August 2020. He is enrolled in Medicare PECOS and is a graduate of Southern College Of Optometry (2020).

NPPES Registry Identity

NPI1104436922
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameKENNETH TREVOR SHEALYCredential: O.D.
Location Address1803 OLD OCILLA RDTifton, GA 31794-1617
Mailing Address1803 Old Ocilla RdTifton, GA 31794-1617 · (229) 386-2181 · Fax (229) 386-2193
Phone(229) 386-2181
Fax(229) 386-2193
Sole ProprietorNo
Medical School CMSSouthern College Of OptometryGraduated 2020
Enumeration DateAugust 6, 2020
Last NPPES UpdateAugust 23, 20242 updates tracked since enumeration
NPPES CertifiedAugust 23, 2024
✔ NPI 1104436922 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
License✔ Licensed in GA · OPT003252
Definition
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
1803 OLD OCILLA RD, Tifton, GA 31794
Open in Google Maps ↗

Other Identifiers 1

OtherOPT003252GA · Optometry License

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kenneth Trevor Shealy O.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7618388570
PECOS Enrollment IDI20201124003123
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Kenneth Shealy reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Tift Regional Health System Inc
Same address
Ophthalmology
1803 OLD OCILLA ROAD
Tifton, GA 31794
  • Reassigned Medicare billing, Georgia enrollment
  • 380 clinicians in this Medicare group
NPI 1790280857 (229) 386-2181
Fitzgerald Family Eyecare, P.C.
37 mi
Optometrist
1329 OCILLA RD
Douglas, GA 31533
  • Reassigned Medicare billing, Georgia enrollment
  • 2 clinicians in this Medicare group
NPI 1114938727 (912) 393-0005

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 9

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
78 services54 patients
Photography of the retina 92250
Photography of the retina, also known as retinal imaging, is a non-invasive procedure that captures images of the back of your eye. This helps doctors identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. It's painless and quick, often part of a routine eye exam.
77 services77 patients
Established patient complete exam of visual system 92014
An established patient complete exam of the visual system involves a thorough check of your eyes and vision. It assesses eye health, checks for diseases, and measures your ability to see clearly at different distances. It's a routine, non-invasive procedure.
51 services51 patients
New patient complete exam of visual system 92004
A new patient complete exam of the visual system is a thorough evaluation of your eyes and vision. It checks for any potential issues and assesses overall eye health. It includes tests for visual acuity, eye movement, and light response.
42 services42 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
34 services33 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
27 services27 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 31794 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$124.10 typical visit price
range $53.31 – $164.04
Typical copayment $31.02 (range $13.32 – $41.01)
Most-billed visit code 99204
Established Patient
$66.89 typical visit price
range $16.68 – $133.24
Typical copayment $16.72 (range $4.17 – $33.31)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

76.05/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality71.18
Promoting Interoperability73
Improvement Activities40

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LARRY R MOORMAN M D, PC
Ophthalmology
1803 OLD OCILLA RD
TIFTON, GA 31794
Tift County (229) 386-2181
TIFTON OPHTHALMOLOGY ASSOCIATES. PC
Ophthalmology
1803 OLD OCILLA RD
TIFTON, GA 31794
Tift County (229) 386-2181
DR. ROBERT JON HOLME M.D.
Ophthalmology
1803 OLD OCILLA RD
TIFTON, GA 31794
Tift County (229) 386-2181
TIFT REGIONAL HEALTH SYSTEM INC.
Eyewear Supplier
1803 OLD OCILLA RD
TIFTON, GA 31794
Tift County (229) 386-2181
DR. BRET BOUTON WAGENHORST M.D.
Ophthalmology
1803 OLD OCILLA RD
TIFTON, GA 31794
Tift County (229) 386-2181
AMEDCO GEORGIA LLC
Ophthalmology
1803 OLD OCILLA RD
TIFTON, GA 31794
Tift County (229) 986-2181

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth Shealy's NPI number?

The NPI number for Kenneth Shealy is 1104436922. It was assigned to this individual provider in the NPPES registry on August 6, 2020.

Where is Kenneth Shealy located?

Kenneth Shealy practices at 1803 Old Ocilla Rd, Tifton, GA 31794. The listed phone number is (229) 386-2181.

What is Kenneth Shealy's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Kenneth Shealy enrolled in Medicare?

Yes. Kenneth Shealy is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Kenneth Shealy's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kenneth Shealy reassigns Medicare benefits to 2 organizations: Tift Regional Health System Inc (Tifton, GA) and Fitzgerald Family Eyecare, P.C. (Douglas, GA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kenneth Shealy's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kenneth Shealy accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama and Ambetter of North Carolina and 6 other insurers list Kenneth Shealy as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kenneth Shealy was last updated on August 23, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.