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DR. SANDRA K DOLPHIN O.D.
NPI 1205863693
Optometrist in St Croix Falls, WI

Active since June 28, 2006PECOS EnrolledAccepts Medicare Assignment
80.2/100
CMS Quality Rating
213 S ADAMS ST, ST CROIX FALLS, WI 54024(715) 483-3259(715) 483-5136 Get Directions Write a Review

NPPES record last updated: October 3, 2011. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Dr. Sandra K Dolphin O.d. NPPES

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

DR. SANDRA K DOLPHIN O.D. (NPI 1205863693) is an individual optometrist in St Croix Falls, Wisconsin, licensed in Wisconsin (2589-035) and active in the NPI registry since June 2006. She is enrolled in Medicare PECOS and is a graduate of University Of Missouri St Louis - School Of Optometry (1994).

NPPES Registry Identity

NPI1205863693
Entity TypeIndividualFemale
Primary Taxonomy152W00000X
Provider Legal NameDR. SANDRA K DOLPHINCredential: O.D.
Location Address213 S ADAMS STSt Croix Falls, WI 54024
Mailing Address213 South Adams StreetSt Croix Falls, WI 54024 · (715) 483-3259 · Fax (715) 483-5136
Phone(715) 483-3259
Fax(715) 483-5136
Sole ProprietorNo
Medical School CMSUniversity Of Missouri St Louis - School Of OptometryGraduated 1994
Enumeration DateJune 28, 2006
Last NPPES UpdateOctober 3, 2011
✔ NPI 1205863693 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 WI · 2589-035
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.
213 S ADAMS ST, St Croix Falls, WI 54024
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Other Identifiers 12

Other511297WI · Nva
OtherP00175525WI · Railroad Medicare
Medicaid38623500WI
Medicare NSC5173080001WI
Other538722180MN · Mn Ma
Other270L2DOWI · Bcbs Mn
Other5173080001Dmepos
Other22-02486WI · Medica/select Care
Medicare UPINU52539WI
Other97969-1007552WI · Preferred One
OtherHP26431WI · Health Partners
Medicare ID-Type Unspecified000149065WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Sandra K Dolphin 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 ID9133192305
PECOS Enrollment IDI20040817000587
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.

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.

Removal of cataract with insertion of prosthetic lens 66984
This is a procedure where a cloudy lens in your eye, known as a cataract, is removed. After removal, a clear artificial lens is inserted. This helps to restore your vision, enabling you to see clearly again.
1,946 services15 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.
211 services211 patients
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.
156 services117 patients
Exam of visual field with extended testing 92083
An extended visual field exam is a detailed test to evaluate your peripheral (side) vision. It helps to detect any potential blind spots which may not be noticeable in daily life. These could be caused by eye diseases like glaucoma, or neurological conditions.
74 services71 patients
Imaging of optic nerve 92133
Imaging of the optic nerve is a non-invasive procedure that captures detailed pictures of your optic nerve. It helps doctors assess eye health, particularly for conditions like glaucoma. It's painless, quick, and uses safe technology like MRI or OCT (Optical Coherence Tomography).
62 services60 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.
38 services38 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54024 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
$123.69 typical visit price
range $53.90 – $163.24
Typical copayment $30.92 (range $13.47 – $40.81)
Most-billed visit code 99204
Established Patient
$67.37 typical visit price
range $17.40 – $133.76
Typical copayment $16.84 (range $4.35 – $33.44)
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.

80.2/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Individually scored
Quality60.41
Improvement Activities40

Reported Quality Measures

Closing the Referral Loop: Receipt of Specialist Report
0%85 patients1/55-star benchmark: 87%
Diabetes: Eye Exam
97%147 patients4/55-star benchmark: 100%
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
74%34 patients3/55-star benchmark: 100%
Documentation of Current Medications in the Medical Record
68%2,044 patients3/55-star benchmark: 100%
Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation
94%177 patients
Use of High-Risk Medications in Older Adults
Lower rates are better for this measure.
0%866 patients5/55-star benchmark: 100%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Frames, purchases V2020
Other-Vision, Hearing, and Speech Services · category OC000N
1 supplier12 claims12 services$60.22 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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 Sandra Dolphin's NPI number?

The NPI number for Sandra Dolphin is 1205863693. It was assigned to this individual provider in the NPPES registry on June 28, 2006.

Where is Sandra Dolphin located?

Sandra Dolphin practices at 213 S Adams St, St Croix Falls, WI 54024. The listed phone number is (715) 483-3259.

What is Sandra Dolphin's specialty?

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

Is Sandra Dolphin enrolled in Medicare?

Yes. Sandra Dolphin 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.

What insurance does Sandra Dolphin accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and HealthPartners and 2 other insurers list Sandra Dolphin 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 Sandra Dolphin was last updated on October 3, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.