DR. BRIAN L HEFFELFINGER M.D.
NPI 1396804290
Ophthalmology in St. Charles, IL

Q: What is Brian Heffelfinger's NPI number?

The NPI number for Brian Heffelfinger is 1396804290. It was assigned to this individual provider in the NPPES registry on December 6, 2006.

Q: What is Brian Heffelfinger's specialty?

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

Active since December 06, 2006PECOS EnrolledAccepts Medicare Assignment

85.41/100

CMS Quality Rating

40W330 LAFOX ROAD, ST. CHARLES, IL 60175(630) 584-9850(630) 584-1523 Get Directions Write a Review

NPPES record last updated: March 27, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Dr. Brian L Heffelfinger M.d. NPPES

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

DR. BRIAN L HEFFELFINGER M.D. (NPI 1396804290) is an individual ophthalmology provider in St. Charles, Illinois and active in the NPI registry since December 2006. He is enrolled in Medicare PECOS, is affiliated with Presence Saint Joseph Hospital - Elgin, and is a graduate of Rush Medical College Of Rush University (1995).

NPPES Registry Identity

NPI1396804290

Entity TypeIndividualMale

Primary Taxonomy207W00000X

Provider Legal NameDR. BRIAN L HEFFELFINGERCredential: M.D.

Location Address40W330 LAFOX ROADSt. Charles, IL 60175

Mailing Address40w330 Lafox RoadSt. Charles, IL 60175 · (630) 584-9850 · Fax (630) 584-1523

Phone(630) 584-9850

Fax(630) 584-1523

Sole ProprietorNo

Medical School CMSRush Medical College Of Rush UniversityGraduated 1995

Enumeration DateDecember 6, 2006

Last NPPES UpdateMarch 27, 2008

✔ NPI 1396804290 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOphthalmologyAllopathic & Osteopathic Physicians

Taxonomy Code207W00000X

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.

40W330 LAFOX ROAD, St. Charles, IL 60175

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Other Identifiers 6

Medicare UPINH08241IL

Other2032261IL · United Healthcare

Other4519570IL · Bcbs

Medicare ID-Type UnspecifiedL77962IL

Medicare NSC0151380001IL

Medicaid36097684IL

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.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. Brian L Heffelfinger 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 ID6608760152

PECOS Enrollment IDI20040214000060

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 15

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.

887 services847 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.

668 services638 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

583 services318 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.

407 services363 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.

323 services301 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).

316 services303 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.

274 services116 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.

208 services186 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.

179 services101 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.

106 services106 patients

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.

52 services41 patients

Exam of the internal drainage system of eye 92020

This is a procedure where your doctor examines the eye's internal drainage system, essential for maintaining eye pressure. They use specialized tools to check for blockages or damage that might lead to conditions like glaucoma. It's non-invasive and painless.

45 services42 patients

Ultrasound scan of cornea to determine thickness 76514

An ultrasound scan of the cornea is a non-invasive procedure that uses sound waves to measure the thickness of your cornea. This helps in diagnosing certain eye conditions and planning treatments. No discomfort or pain is typically experienced.

38 services38 patients

Extended exam of the back part of the eye with retinal drawing 92201

This procedure involves a detailed examination of the back part of your eye, including the retina. It helps identify any abnormalities or issues. A retinal drawing is made to record findings. It's non-invasive and crucial for maintaining eye health.

19 services19 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

17 services17 patients

Hospital Affiliations CMS Care Compare

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

Presence Saint Joseph Hospital - Elgin

Acute Care Hospitals · Elgin, IL

3/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number140217

Location77 N Airlite StreetElgin, IL 60123 · Kane County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60175 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

$137.43 typical visit price

range $59.81 – $181.38

Typical copayment $34.35 (range $14.95 – $45.34)

Most-billed visit code 99204

Established Patient

$74.38 typical visit price

range $19.15 – $147.12

Typical copayment $18.59 (range $4.78 – $36.78)

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.

85.41/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

100

Improvement Activities

Cost

51.37

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 supplier23 claims23 services$57.74 avg. paid by Medicare

Sphere, trifocal, plano to plus or minus 4.00d, per lens V2300

Other-Vision, Hearing, and Speech Services · category OC000N

1 supplier13 claims26 services$54.63 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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Other Providers at the Same Location NPPES 5

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

DR. MARIA PICA O.D.

Optometrist

40W330 LAFOX ROAD
ST. CHARLES, IL 60175

Kane County (630) 584-9850

DR. ERIC J QUARTETTI M.D.

Ophthalmology

40W330 LAFOX ROAD
ST. CHARLES, IL 60175

Kane County (630) 584-9850

DR. ALEXANDRIA P HALKIAS O.D.

Optometrist

40W330 LAFOX ROAD
ST. CHARLES, IL 60175

Kane County (630) 584-9850

FOX VALLEY OPHTHALMOLOGY

Ophthalmology

40W330 LAFOX ROAD
ST. CHARLES, IL 60175

Kane County (630) 584-9850

DR. BRIAN MICHAEL PENNIALL D.D.S.

Dentist

40W330 LAFOX ROAD, SUITE C-1
SAINT CHARLES, IL 60175

Kane County (630) 444-1730

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 Brian Heffelfinger's NPI number?

The NPI number for Brian Heffelfinger is 1396804290. It was assigned to this individual provider in the NPPES registry on December 6, 2006.

Where is Brian Heffelfinger located?

Brian Heffelfinger practices at 40w330 Lafox Road, St. Charles, IL 60175. The listed phone number is (630) 584-9850.

What is Brian Heffelfinger's specialty?

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

Is Brian Heffelfinger enrolled in Medicare?

Yes. Brian Heffelfinger 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 Brian Heffelfinger accept?

Health plans from Providence Health Plan list Brian Heffelfinger 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 Brian Heffelfinger affiliated with any hospitals?

According to CMS data, Brian Heffelfinger is affiliated with Presence Saint Joseph Hospital - Elgin.

When was this NPI record last updated?

The NPPES record for Brian Heffelfinger was last updated on March 27, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.