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DR. JAY EGOLF M.D.
NPI 1225085251
Ophthalmology in Portsmouth, OH

Active since May 27, 2006PECOS EnrolledAccepts Medicare Assignment
78.68/100
CMS Quality Rating
1400 GAY ST, PORTSMOUTH, OH 45662(866) 587-8790(740) 774-4061 Get Directions Write a Review

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

About Dr. Jay Egolf M.d. NPPES

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

DR. JAY EGOLF M.D. (NPI 1225085251) is an individual ophthalmology provider in Portsmouth, Ohio, licensed in Ohio (35083563) and active in the NPI registry since May 2006. He is enrolled in Medicare PECOS, is affiliated with Wilson Memorial Hospital, and maintains 4 additional practice locations.

NPPES Registry Identity

NPI1225085251
Entity TypeIndividualMale
Primary Taxonomy207W00000X
Provider Legal NameDR. JAY EGOLFCredential: M.D.
Location Address1400 GAY STPortsmouth, OH 45662-3475
Mailing Address50 N Plaza BlvdChillicothe, OH 45601-1757 · (866) 587-8790 · Fax (740) 774-4061
Phone(866) 587-8790
Fax(740) 774-4061
Sole ProprietorNo
Medical School CMSJefferson Medical College Of Thomas Jefferson UniversityGraduated 2000
Enumeration DateMay 27, 2006
Last NPPES UpdateJuly 23, 2024
NPPES CertifiedJuly 23, 2024
✔ NPI 1225085251 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOphthalmologyAllopathic & Osteopathic Physicians
Taxonomy Code207W00000X
License✔ Licensed in OH · 35083563
Definition
An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.
1400 GAY ST, Portsmouth, OH 45662
Open in Google Maps ↗

Secondary Practice Locations 4

Location 11861 Towne Park Dr Ste CTroy, OH 45373-2067 · Phone (513) 984-5133
Location 21118 Fairington DrSidney, OH 45365-8913 · Phone (513) 984-5133
Location 31219 Recker RdPiqua, OH 45356-4113 · Phone (513) 984-5133
Location 41449 S Main StBellefontaine, OH 43311-1503 · Phone (513) 984-5133

Other Identifiers 1

Medicaid2483950OH

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, 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

Dr. Jay Egolf M.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 ID6103819495
PECOS Enrollment IDI20040405000197
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 Jay Egolf reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Eye Specialist Inc
Same address
Ophthalmology
1400 GAY STREET
Portsmouth, OH 45662
  • Reassigned Medicare billing, Ohio enrollment
  • 13 clinicians in this Medicare group
NPI 1912956145 (740) 351-0999
Cei Physicians Psc LLC
82 mi
Ophthalmology
1945 CEI DR
Cincinnati, OH 45242
  • Reassigned Medicare billing, Ohio enrollment
  • 225 clinicians in this Medicare group
NPI 1942296298 (513) 569-3741

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 14

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.

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.
370 services238 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.
369 services275 patients
Established patient problem focused exam of visual system 92012
This is a routine check-up for existing patients focusing on the visual system. It involves examining your eyes to detect any potential issues or changes in your vision. It's a crucial part of maintaining good eye health.
252 services212 patients
Measurement of corneal curvature and depth of eye 92136
This procedure measures the shape and depth of your eye, specifically the cornea, the clear front surface. It helps in diagnosing conditions, planning for surgeries, or fitting contact lenses. It's non-invasive and painless.
202 services136 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.
186 services126 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).
135 services120 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Wilson Memorial Hospital

Acute Care Hospitals · Sidney, OH
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number360013
Location915 West Michigan StreetSidney, OH 45365 · Shelby County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 45662 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
$126.12 typical visit price
range $54.34 – $166.65
Typical copayment $31.53 (range $13.58 – $41.66)
Most-billed visit code 99204
Established Patient
$68.07 typical visit price
range $17.10 – $135.40
Typical copayment $17.01 (range $4.27 – $33.85)
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.

78.68/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality100
Improvement Activities40
Cost28.94

Reported Quality Measures

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
92%104 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.
85%635 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.
98%791 patients4/55-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.
95%2,344 patients4/55-star benchmark: 99%
Pneumococcal Vaccination Status for Older Adults
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
60%91 patients3/55-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…
91%2,344 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…
1%2,344 patients1/55-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.

Other Providers at the Same Location NPPES

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

PORTSMOUTH SURGERY CENTER, INC
Clinic/Center (Ambulatory Surgical)
1400 GAY ST
PORTSMOUTH, OH 45662
Scioto County (740) 351-0999

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 Jay Egolf's NPI number?

The NPI number for Jay Egolf is 1225085251. It was assigned to this individual provider in the NPPES registry on May 27, 2006.

Where is Jay Egolf located?

Jay Egolf practices at 1400 Gay St, Portsmouth, OH 45662. The listed phone number is (866) 587-8790.

What is Jay Egolf's specialty?

The primary specialty registered for this NPI is Ophthalmology with taxonomy code 207W00000X.

Is Jay Egolf enrolled in Medicare?

Yes. Jay Egolf 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 Jay Egolf's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jay Egolf reassigns Medicare benefits to 2 organizations: Eye Specialist Inc (Portsmouth, OH) and Cei Physicians Psc LLC (Cincinnati, OH). 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 Jay Egolf's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jay Egolf accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Anthem Blue Cross and Blue Shield and Antidote Health Plan of Ohio, Inc. and 5 other insurers list Jay Egolf 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.

Is Jay Egolf affiliated with any hospitals?

According to CMS data, Jay Egolf is affiliated with Wilson Memorial Hospital.

When was this NPI record last updated?

The NPPES record for Jay Egolf was last updated on July 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.