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DR. JOHN ERIC PAULSEN O.D.
NPI 1215921234
Optometrist in Sturgeon Bay, WI

Active since September 06, 2005PECOS EnrolledAccepts Medicare Assignment
88.84/100
CMS Quality Rating
165 N 3RD AVE, STURGEON BAY, WI 54235(920) 743-2020(920) 743-9601 Get Directions Write a Review

NPPES record last updated: January 14, 2014. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Dr. John Eric Paulsen O.d. NPPES

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

DR. JOHN ERIC PAULSEN O.D. (NPI 1215921234) is an individual optometrist in Sturgeon Bay, Wisconsin, licensed in Wisconsin (1895) and active in the NPI registry since September 2005. He is enrolled in Medicare PECOS and is a graduate of Illinois College Of Optometry At Chicago (1982).

NPPES Registry Identity

NPI1215921234
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameDR. JOHN ERIC PAULSENCredential: O.D.
Location Address165 N 3RD AVESturgeon Bay, WI 54235-2415
Mailing Address165 N 3rd AveSturgeon Bay, WI 54235-2415 · (920) 743-2020 · Fax (920) 743-9601
Phone(920) 743-2020
Fax(920) 743-9601
Sole ProprietorYes
Medical School CMSIllinois College Of Optometry At ChicagoGraduated 1982
Enumeration DateSeptember 6, 2005
Last NPPES UpdateJanuary 14, 2014
✔ NPI 1215921234 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 · 1895
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.
165 N 3RD AVE, Sturgeon Bay, WI 54235
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Other Identifiers 3

Medicaid38519100WI
Medicare UPINT62967WI
Medicare ID-Type Unspecified87122WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, CareSource (Common Ground Healthcare), HealthPartners 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. John Eric Paulsen 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 ID345251831
PECOS Enrollment IDI20060516000028
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 recurring cataract in lens capsule using a laser 66821
This procedure, known as YAG laser capsulotomy, treats cloudiness in the lens capsule following cataract surgery. A laser is used to create a small hole in the cloudy capsule, allowing light to pass through and restore clear vision. It's a quick, painless procedure.
4,676 services53 patients
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.
3,415 services26 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.
509 services508 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.
307 services159 patients
Imaging of retina 92134
Imaging of the retina is a non-invasive procedure that captures detailed images of your eye's interior. This helps detect conditions like macular degeneration or retinal detachment. It's painless and takes only a few minutes.
134 services127 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.
104 services103 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54235 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.

88.84/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality77.68
Improvement Activities40

Reported Quality Measures

Closing the Referral Loop: Receipt of Specialist Report
Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred
95%266 patients5/55-star benchmark: 95%
Diabetes: Eye Exam
Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period
99%71 patients4/55-star benchmark: 100%
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus…
16%37 patients1/55-star benchmark: 100%
Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during…
82%45 patients4/55-star benchmark: 100%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
86%180 patients4/55-star benchmark: 100%
Medication Reconciliation
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
85%53 patients3/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
96%1,009 patients4/55-star benchmark: 99%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
0%286 patients1/55-star benchmark: 100%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Patients tobacco: 98% · 424 patients
99%424 patients
Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation
Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits within 12 months
99%155 patients4/55-star benchmark: 100%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
94%1,009 patients4/55-star benchmark: 100%
Secure Messaging
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…
75%1,009 patients5/55-star benchmark: 59%
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 2

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 supplier28 claims28 services$53.31 avg. paid by Medicare
Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens V2303
Other-Vision, Hearing, and Speech Services · category OC000N
1 supplier20 claims32 services$55.21 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 4

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

DR. LAUREN RENEE LODHOLZ O.D.
Optometrist
165 N 3RD AVE
STURGEON BAY, WI 54235
Door County (920) 743-2020
DR. SAI OAK OD
Optometrist
165 N 3RD AVE
STURGEON BAY, WI 54235
Door County (920) 743-2020
ANNIKA PAULSEN OD
Optometrist
165 N 3RD AVE
STURGEON BAY, WI 54235
Door County (920) 743-2020
DOOR COUNTY EYE ASSOCIATES, INC
Optometrist
165 N 3RD AVE
STURGEON BAY, WI 54235
Door County (920) 743-2020

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 John Paulsen's NPI number?

The NPI number for John Paulsen is 1215921234. It was assigned to this individual provider in the NPPES registry on September 6, 2005.

Where is John Paulsen located?

John Paulsen practices at 165 N 3rd Ave, Sturgeon Bay, WI 54235. The listed phone number is (920) 743-2020.

What is John Paulsen's specialty?

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

Is John Paulsen enrolled in Medicare?

Yes. John Paulsen 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 John Paulsen accept?

Health plans from Anthem Blue Cross and Blue Shield, CareSource (Common Ground Healthcare), HealthPartners and Network Health list John Paulsen 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 John Paulsen was last updated on January 14, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.