DR. JOHN J OFFERLE O.D.
NPI 1285639252
Optometrist in South Bend, IN


Quality Rating: 100 out of 100 score

NPI Status: Active since June 16, 2005

Contact Information

17477 GENERATIONS DR
SOUTH BEND, IN
ZIP 46635
Phone: (574) 287-0890
Fax: (574) 287-0899

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  • Individual
  • Male
  • Years of Experience 45
  • Optometrist
  • PECOS Enrolled
  • Accepts Medicare Approved Payment
  • Medicare Quality Reporting

About JOHN OFFERLE

John Offerle is a provider established in South Bend, Indiana and his medical specialization is Optometrist with more than 45 years of experience. He graduated from Indiana University - School Of Optometry in 1979. The healthcare provider is registered in the NPI registry with number 1285639252 assigned on June 2005. The practitioner's primary taxonomy code is 152W00000X with license number 18001874 (IN). The provider is registered as an individual and his NPI record was last updated 17 years ago.

NPI
1285639252
Provider Name
DR. JOHN J OFFERLE O.D.
Gender
Male
Entity Type
Individual
Location Address
17477 GENERATIONS DR SOUTH BEND, IN 46635
Location Phone
(574) 287-0890
Location Fax
(574) 287-0899
Mailing Address
17477 GENERATIONS DR SOUTH BEND, IN 46635
Mailing Phone
(574) 287-0890
Mailing Fax
(574) 287-0899
Medical School Name
INDIANA UNIVERSITY - SCHOOL OF OPTOMETRY
Graduation Year
1979
Is Sole Proprietor?
No
Enumeration Date
06-16-2005
Last Update Date
07-08-2007
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John Offerle is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 100, based on four performance areas: quality, improvement activities, promoting interoperability, and cost. The purpose of this information is to help people with Medicare make informed decisions and incentivize doctors and clinicians to maximize performance. The following quality measures were reported for this provider: diabetes: eye exam.

The typical physician office visit costs for Medicare beneficiaries in this area are: $31.7 for a new patient copayment and $17.24 for an established patient copayment.

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Optometrist

Taxonomy Code
152W00000X
Type
Eye and Vision Services Providers
License No.
18001874
License State
IN
Taxonomy Description
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.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Ambetter from Buckeye Health Plan

    • Choice Bronze HSA - HMO
    • Choice Bronze HSA + Vision + Adult Dental - HMO
    • Clear Gold - HMO
    • Clear Gold + Vision + Adult Dental - HMO
    • Clear Silver - HMO
  • Ambetter from Meridian

    • Ambetter Virtual Access Bronze (Virtual PCP selection required) - HMO
    • Ambetter Virtual Access Gold (Virtual PCP selection required) - HMO
    • Ambetter Virtual Access Silver (Virtual PCP selection required) - HMO
    • Choice Bronze HSA - HMO
    • Choice Bronze HSA + Vision + Adult Dental - HMO
  • Ambetter from MHS

    • Choice Bronze HSA - EPO
    • Choice Bronze HSA + Vision + Adult Dental - EPO
    • Clear Silver - EPO
    • Clear Silver + Vision + Adult Dental - EPO
    • Complete Gold - EPO
  • Ambetter of Illinois

    • Central Bronze - HMO
    • Central Bronze + Vision + Adult Dental - HMO
    • Central Gold - HMO
    • Central Gold + Vision + Adult Dental - HMO
    • Central Silver - HMO
  • Blue Cross and Blue Shield of Illinois

    • Blue Choice Preferred Bronze PPO℠ 201 - PPO
    • Blue Choice Preferred Bronze PPO℠ 202 - PPO
    • Blue Choice Preferred Bronze PPO℠ 601 - Rx Copays - PPO
    • Blue Choice Preferred Bronze PPO℠ 701 - Rx Copays - PPO
    • Blue Choice Preferred Bronze PPO℠ 708 - PPO
  • Blue Cross and Blue Shield of Montana

    • Blue Focus Bronze POS℠ 205 - POS
    • Blue Focus Bronze POS℠ 705 - POS
    • Blue Focus Bronze POS℠ 708 - POS
    • Blue Focus Gold POS℠ 207 - POS
    • Blue Focus Gold POS℠ 707 - POS
  • Blue Cross and Blue Shield of Oklahoma

    • Blue Advantage Bronze PPO℠ 801 - PPO
    • Blue Advantage Bronze PPO℠ 202 - PPO
    • Blue Advantage Bronze PPO℠ 203 - PPO
    • Blue Advantage Gold PPO℠ 309 - PPO
    • Blue Advantage Gold PPO℠ 604 - PPO
  • Blue Cross and Blue Shield of Texas

    • Blue Advantage Bronze HMO℠ 204 - HMO
    • Blue Advantage Bronze HMO℠ 301 - HMO
    • Blue Advantage Bronze HMO℠ 302 - HMO
    • Blue Advantage Bronze HMO℠ 707 - HMO
    • Blue Advantage Gold HMO℠ 206 - HMO
  • Medicare

  • Medicaid


*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
T35013MEDICARE UPIN (02)IN 
736590MEDICARE ID-TYPE UNSPECIFIED (04)IN 
100091030BMEDICAID (05)IN 
200247660MEDICAID (05)IN 

PECOS Enrollment and Medicare Participation Status

John Offerle is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME) and a Home Health Agency (HHA).

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • PECOS PAC ID: 7012927890

    What is the PECOS Associate Control ID?
    A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

  • PECOS Enrollment ID: I20060424000358

    What is the Provider Enrollment ID?
    The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

  • Accepts Medicare Assignment? Yes

    What does it mean "accepts medicare assignment"?
    When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
    A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): Yes

  • Eligible to Order or Refer Power Mobility Devices: No

Physician Visit Costs

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 46635 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99204

  • Average New Patient Price $126.81
  • Minimum New Patient Price $54.76
  • Maximum New Patient Price $167.54
  • Average New Patient Copayment $31.7
  • Minimum New Patient Copayment $13.69
  • Maximum New Patient Copayment $41.88

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

  • Average Established Patient Price $68.99
  • Minimum Established Patient Price $16.96
  • Maximum Established Patient Price $137.16
  • Average Established Patient Copayment $17.24
  • Minimum Established Patient Copayment $4.24
  • Maximum Established Patient Copayment $34.29

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Overall MIPS Quality Performance

The Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS Quality Payment Program (QPP). The MIPS program affects clinician reimbursement for Part B covered professional services and also rewards them for improving the quality of patient care and outcomes.

  • Final Score: 100 out of 100

    The MIPS program evaluates providers across multiple categories with a specific weight for each category resulting a in a MIPS final score that ranges from 0 to 100 points. The MIPS Final Score determines whether providers receive a negative, neutral or positive MIPS payment adjustment.

  • Quality Score: 100

    The Quality category assesses providers performance on clinical practices and patient outcomes under the traditional MIPS program. The quality measures help identify the quality of healthcare processes, outcomes, and patient experiences. The Quality measure category compromises 40% providers final MPIS scores.

    There are six collection types for MIPS quality measures: Electronic Clinical Quality Measures (eCQMs), MIPS Clinical Quality Measures (CQMs), Qualified Clinical Data Registry (QCDR) Measures, Medicare Part B claims measures, CMS Web Interface measures and The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey.

  • Promoting Interoperability Score: N/A

    The Interoperability category measures the providers ability to use technology to exchange and make use of healthcare information in a way that is less burdensome and improves outcomes. The Interoperability measure category compromises 25% providers final MPIS scores.

    The MIPS Interoperability measure focuses on the use of certified electronic health record technology (CEHRT) to improve patient access health information, the exchange of information between clinicians and pharmacies and the systematic collection, analysis, and interpretation of healthcare data.

  • Improvement Activities Score: 40

    The Improvement Activities performance category evaluates the providers participation in clinical activities that support the improvement of clinical practice, care delivery, and outcomes. Providers have the option to choose 2 to 4 activities from an inventory of over 100 improvement activities. Providers typically choose the activities that best fit their needs. The improvement activities measure category compromises 15% providers final MPIS scores.

    The Improvement measures aim to better patient engagement, patient safety and other areas of patient care. The Improvement Activities category compromises 15% of providers final MPIS scores.

  • Cost Score: N/A

    The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.

    Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.

  • Cost Score: N/A

    The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.

    Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.

Quality Reporting

The following quality measures meet Medicare's statistical reporting standards for the year 2018. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

Quality Measure Performance Number of Patients
Diabetes: Eye Exam 100% 32
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

Clinician Services

The following Healthcare Common Procedure Coding System (HCPCS) codes were publicly reported as the top services rendered by this provider under the Medicare program for the year 2020. The reported codes are based on the top 5 codes for each available specialty, excluding evaluation and management codes.

  • 100

    Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits (HCPCS:92014)

  • 85

    Photography of the retina (HCPCS:92250)

  • 82

    Measurement of field of vision during daylight conditions (HCPCS:92083)

  • 69

    Diagnostic imaging of optic nerve of eye (HCPCS:92133)

  • 44

    Diagnostic imaging of retina (HCPCS:92134)

Reviews for DR. JOHN J OFFERLE O.D.

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1285639252
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2216512318210
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 2 + 1 + 6 + 5 + 1 + 2 + 3 + 1 + 8 + 2 + 1 + 0 + 24 = 58
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 58 = 22

The NPI number 1285639252 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 3 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1558366518DR. TOM L MORTON O.D.
Individual
Optometrist17477 GENERATIONS DR
SOUTH BEND, IN 46635
(574) 287-0890
1639482904 KRISTINA OFFERLE O.D.
Individual
Optometrist17477 GENERATIONS DR
SOUTH BEND, IN 46635
(574) 287-0890
1689610305EYECARE ASSOCIATES OF MICHIANA, LLC
Organization
Optometrist17477 GENERATIONS DR
SOUTH BEND, IN 46635
(574) 287-0890

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1285639252, enumerated in the NPI registry as an "individual" on June 16, 2005

The provider is located at 17477 Generations Dr South Bend, In 46635 and the phone number is (574) 287-0890

The provider's speciality is Optometrist with taxonomy code 152W00000X

The provider has more than 45 years of experience. He graduated from Indiana University - School Of Optometry in 1979.

The provider might be accepting Accepts: Ambetter from Buckeye Health Plan, Ambetter from. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Yes, as of June 11, 2024 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME) and a Home Health Agency (HHA).

The provider has an overall high rating in the following quality measures: quality clinical practices and patient outcomes and experiences.

Medicare beneficiaries should expect a typical cost of $126.81 with an average copayment of $31.7 for new patient appointments. Established patients should expect a typical charge of $68.99 and an average copayment of 17.24. Please review your insurance plan or contact the provider directly to determine your specific costs.

The most common procedures or services performed by this practitioner are: Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits, Photography of the retina, Measurement of field of vision during daylight conditions, Diagnostic imaging of optic nerve of eye and Diagnostic imaging of retina.

This NPI record was last updated on June 16, 2005. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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