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DR. DUANE ALLEN TOLSMA O.D.
NPI 1306841630
Optometrist in Saint Joseph, MI

Active since June 14, 2005PECOS EnrolledAccepts Medicare Assignment
100/100
CMS Quality Rating
2848 NILES RD, SAINT JOSEPH, MI 49085(269) 428-3300(269) 428-5005 Get Directions Write a Review

NPPES record last updated: April 26, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Duane Allen Tolsma O.d. NPPES

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

DR. DUANE ALLEN TOLSMA O.D. (NPI 1306841630) is an individual optometrist in Saint Joseph, Michigan, licensed in Michigan (4901003188) and active in the NPI registry since June 2005. He is enrolled in Medicare PECOS, is affiliated with Lakeland Hospital, St Joseph, and is a graduate of Ferris State College - College Of Optometry (1988).

NPPES Registry Identity

NPI1306841630
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameDR. DUANE ALLEN TOLSMACredential: O.D.
Location Address2848 NILES RDSaint Joseph, MI 49085-3352
Mailing Address2848 Niles RdSaint Joseph, MI 49085-3352 · (269) 428-3300 · Fax (269) 428-5005
Phone(269) 428-3300
Fax(269) 428-5005
Sole ProprietorNo
Medical School CMSFerris State College - College Of OptometryGraduated 1988
Enumeration DateJune 14, 2005
Last NPPES UpdateApril 26, 2023
NPPES CertifiedApril 26, 2023
✔ NPI 1306841630 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 MI · 4901003188
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.
2848 NILES RD, Saint Joseph, MI 49085
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Other Identifiers 2

Medicaid1956841MI
Medicaid944911629MI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, McLaren Health Plan Community 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. Duane Allen Tolsma 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 ID6800911728
PECOS Enrollment IDI20100916000126
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 11

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 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.
497 services493 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.
370 services256 patients
Exam to measure eye deviation and range of motion 92060
This is an eye exam that checks for any misalignment in your eyes, also known as deviation. It also assesses the movement range of your eyes. The procedure is painless and helps in detecting conditions like strabismus or other vision issues.
126 services86 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.
68 services63 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).
59 services59 patients
Closure of tear duct opening using plug 68761
Closure of the tear duct opening using a plug is a procedure to address excessive tear production. A small device is inserted into the tear duct to block it, reducing tear flow and relieving symptoms. This is a safe, reversible process, often performed in-office.
39 services18 patients

Hospital Affiliations CMS Care Compare

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

Lakeland Hospital, St Joseph

Acute Care Hospitals · St Joseph, MI
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number230021
Location1234 Napier AvenueSt Joseph, MI 49085 · Berrien County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 49085 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
$126.15 typical visit price
range $54.34 – $166.68
Typical copayment $31.53 (range $13.58 – $41.67)
Most-billed visit code 99204
Established Patient
$68.07 typical visit price
range $17.09 – $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.

100/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality87.54
Promoting Interoperability100
Improvement Activities40

Reported Quality Measures

Care Plan
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker…
27%234 patients1/55-star benchmark: 100%
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
100%106 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.

Other Providers at the Same Location NPPES 16

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

DR. BENJAMIN P NICHOLSON M.D., M.A.
Ophthalmology (Retina Specialist)
2848 NILES RD
SAINT JOSEPH, MI 49085
Berrien County (269) 428-3300
GREAT LAKES SURGERY CENTER LLC
Clinic/Center (Ambulatory Surgical)
2848 NILES RD, SUITE B
SAINT JOSEPH, MI 49085
Berrien County (269) 428-3304
NICHOLAS GEORGE KEINATH OD
Optometrist
2848 NILES RD
SAINT JOSEPH, MI 49085
Berrien County (269) 428-3300
DR. JENNA ELISE STODDARD OD
Optometrist
2848 NILES RD
SAINT JOSEPH, MI 49085
Berrien County (269) 428-3300
DR. DANIEL JAMES VAN ELK OD
Optometrist
2848 NILES RD
SAINT JOSEPH, MI 49085
Berrien County (269) 428-3300
LAKESHORE ANESTHESIA STAFFING LLC
Nurse Anesthetist, Certified Registered
2848 NILES RD
SAINT JOSEPH, MI 49085
Berrien County (269) 932-4388
DR. DAVID NEAL BROWN M.D.
Ophthalmology
2848 NILES RD
SAINT JOSEPH, MI 49085
Berrien County (269) 428-3300
DR. STANLEY W PLETCHER M.D.
Ophthalmology
2848 NILES RD
SAINT JOSEPH, MI 49085
Berrien County (269) 428-3300

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 Duane Tolsma's NPI number?

The NPI number for Duane Tolsma is 1306841630. It was assigned to this individual provider in the NPPES registry on June 14, 2005.

Where is Duane Tolsma located?

Duane Tolsma practices at 2848 Niles Rd, Saint Joseph, MI 49085. The listed phone number is (269) 428-3300.

What is Duane Tolsma's specialty?

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

Is Duane Tolsma enrolled in Medicare?

Yes. Duane Tolsma 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 Duane Tolsma accept?

Health plans from Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, McLaren Health Plan Community and Priority Health list Duane Tolsma 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 Duane Tolsma affiliated with any hospitals?

According to CMS data, Duane Tolsma is affiliated with Lakeland Hospital, St Joseph.

When was this NPI record last updated?

The NPPES record for Duane Tolsma was last updated on April 26, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.