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DR. NATHAN KIRBY OD
NPI 1558719054
Optometrist in Hillsboro, IL

Active since May 25, 2016PECOS EnrolledAccepts Medicare Assignment
89.41/100
CMS Quality Rating
675 SCHOOL ST, HILLSBORO, IL 62049(217) 532-5044 Get Directions Write a Review

NPPES record last updated: February 28, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 28, 2019, Nov 8, 2016 (2 updates tracked since 2016).

About Dr. Nathan Kirby Od NPPES

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

DR. NATHAN KIRBY OD (NPI 1558719054) is an individual optometrist in Hillsboro, Illinois, licensed in Illinois (046.010979) and active in the NPI registry since May 2016. He is enrolled in Medicare PECOS, maintains a secondary practice location in East St Louis, and is a graduate of University Of Missouri St Louis - School Of Optometry (2015).

NPPES Registry Identity

NPI1558719054
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameDR. NATHAN KIRBYCredential: OD
Location Address675 SCHOOL STHillsboro, IL 62049-1530
Mailing Address675 School StHillsboro, IL 62049-1530 · (217) 532-5044
Phone(217) 532-5044
Sole ProprietorNo
Medical School CMSUniversity Of Missouri St Louis - School Of OptometryGraduated 2015
Enumeration DateMay 25, 2016
Last NPPES UpdateFebruary 28, 20192 updates tracked since enumeration
✔ NPI 1558719054 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 IL · 046.010979
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.
675 SCHOOL ST, Hillsboro, IL 62049
Open in Google Maps ↗

Secondary Practice Location 1

Location 1601 JAMES R THOMPSON BLVD, BLDG D STE 2030EAST ST LOUIS, IL 62201 · Phone (618) 274-0169 · Fax (618) 274-0781

Other Identifiers 1

Medicaid046010979IL

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter Health, Ambetter Health of Delaware 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. Nathan Kirby Od 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 ID3678863776
PECOS Enrollment IDI20160601002869
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 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.
3,422 services26 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.
347 services292 patients
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203
This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
46 services46 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.
41 services32 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.
36 services35 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).
30 services28 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 62049 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
$131.14 typical visit price
range $56.28 – $173.35
Typical copayment $32.78 (range $14.07 – $43.33)
Most-billed visit code 99204
Established Patient
$70.42 typical visit price
range $17.51 – $139.99
Typical copayment $17.60 (range $4.37 – $34.99)
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.

89.41/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Individually scored
Quality78.82
Improvement Activities40

Reported Quality Measures

Closing the Referral Loop: Receipt of Specialist Report
64%118 patients3/55-star benchmark: 87%
Diabetes: Eye Exam
97%237 patients4/55-star benchmark: 100%
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
92%59 patients4/55-star benchmark: 100%
Documentation of Current Medications in the Medical Record
92%2,096 patients4/55-star benchmark: 100%
Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation
86%74 patients
Use of High-Risk Medications in Older Adults
Lower rates are better for this measure.
0%746 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 4

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

DOUGLAS W JOHNSON OD
Optometrist
675 SCHOOL ST
HILLSBORO, IL 62049
Montgomery County (217) 532-5044
ERIC JOHNSON OD
Optometrist
675 SCHOOL ST
HILLSBORO, IL 62049
Montgomery County (217) 532-5044
FAMILY EYE CARE ASSOCIATION, P.C.
Optometrist
675 SCHOOL ST
HILLSBORO, IL 62049
Montgomery County (217) 532-5044
SCOTT M SAWYER OD
Optometrist
675 SCHOOL ST
HILLSBORO, IL 62049
Montgomery County (217) 532-5044

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 Nathan Kirby's NPI number?

The NPI number for Nathan Kirby is 1558719054. It was assigned to this individual provider in the NPPES registry on May 25, 2016.

Where is Nathan Kirby located?

Nathan Kirby practices at 675 School St, Hillsboro, IL 62049. The listed phone number is (217) 532-5044.

What is Nathan Kirby's specialty?

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

Is Nathan Kirby enrolled in Medicare?

Yes. Nathan Kirby 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 Nathan Kirby accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Home State Health, Blue Cross Blue Shield of Wyoming and Blue Cross and Blue Shield of Louisiana and 4 other insurers list Nathan Kirby 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 Nathan Kirby was last updated on February 28, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.