SHANE BENALLY OD
NPI 1588387294
Optometrist in Santo Domingo Pueblo, NM

Q: What is Shane Benally's NPI number?

The NPI number for Shane Benally is 1588387294. It was assigned to this individual provider in the NPPES registry on September 19, 2022.

Q: What is Shane Benally's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Shane Benally was last updated on July 22, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months 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.

Active since September 19, 2022PECOS EnrolledAccepts Medicare Assignment

85 W HIGHWAY 22, SANTO DOMINGO PUEBLO, NM 87052(505) 465-1169 Get Directions Write a Review

NPPES record last updated: July 22, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Shane Benally Od NPPES

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

SHANE BENALLY OD (NPI 1588387294) is an individual optometrist in Santo Domingo Pueblo, New Mexico, licensed in Idaho (ODP-100585) and active in the NPI registry since September 2022. He is enrolled in Medicare PECOS and is a graduate of Southern College Of Optometry (2022).

NPPES Registry Identity

NPI1588387294

Entity TypeIndividualMale

Primary Taxonomy152W00000X

Provider Legal NameSHANE BENALLYCredential: OD

Location Address85 W HIGHWAY 22Santo Domingo Pueblo, NM 87052-1283

Mailing Address5300 Las Soleras Dr Apt 6003Santa Fe, NM 87507-2002 · (901) 653-5701

Phone(505) 465-1169

Sole ProprietorNo

Medical School CMSSouthern College Of OptometryGraduated 2022

Enumeration DateSeptember 19, 2022

Last NPPES UpdateJuly 22, 2025

NPPES CertifiedJuly 22, 2025

✔ NPI 1588387294 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 ID · ODP-100585

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.

85 W HIGHWAY 22, Santo Domingo Pueblo, NM 87052

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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

Shane Benally 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 ID7810341260

PECOS Enrollment IDI20231004000022

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 7

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 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.

99 services63 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.

35 services34 patients

Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

35 services34 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.

31 services29 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.

22 services20 patients

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.

16 services16 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 87052 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

$126.21 typical visit price

range $54.26 – $166.80

Typical copayment $31.55 (range $13.56 – $41.70)

Most-billed visit code 99204

Established Patient

$68.00 typical visit price

range $17.00 – $135.35

Typical copayment $17.00 (range $4.25 – $33.83)

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.

Other Providers at the Same Location NPPES 14

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

KEWA PUEBLO HEALTH CORPORATION

Clinic/Center (Dental)

85 W HIGHWAY 22
SANTO DOMINGO, NM 87052

Sandoval County (505) 465-3060

CARMEN SALAZAR CNP

Nurse Practitioner (Family)

85 W HIGHWAY 22
SANTO DOMINGO PUEBLO, NM 87052

Sandoval County (505) 465-3060

JOHANNAH RENEE YAZZIE CPNP-PC

Nurse Practitioner (Pediatrics)

85 W HIGHWAY 22
SANTO DOMINGO PUEBLO, NM 87052

Sandoval County (505) 465-3060

KEWA PUEBLO HEALTH CORPORATION

Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy

85 W HIGHWAY 22
SANTO DOMINGO, NM 87052

Sandoval County (505) 465-3060

JAMES D LUTZ MD

Family Medicine

85 W HIGHWAY 22
SANTO DOMINGO PUEBLO, NM 87052

Sandoval County (505) 465-3060

JASMINE JO LATOMA RN

Registered Nurse

85 W HIGHWAY 22
SANTO DOMINGO PUEBLO, NM 87052

Sandoval County (505) 465-3060

KEWA PUEBLO HEALTH CORPORATION

Optometrist

85 W HIGHWAY 22
SANTO DOMINGO, NM 87052

Sandoval County (505) 465-3060

KEWA PUEBLO HEALTH CORPORATION

Clinic/Center (Federally Qualified Health Center (FQHC))

85 W HIGHWAY 22
SANTO DOMINGO PUEBLO, NM 87052

Sandoval County (505) 465-3060

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 Shane Benally's NPI number?

The NPI number for Shane Benally is 1588387294. It was assigned to this individual provider in the NPPES registry on September 19, 2022.

Where is Shane Benally located?

Shane Benally practices at 85 W Highway 22, Santo Domingo Pueblo, NM 87052. The listed phone number is (505) 465-1169.

What is Shane Benally's specialty?

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

Is Shane Benally enrolled in Medicare?

Yes. Shane Benally 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 Shane Benally accept?

Health plans from Providence Health Plan list Shane Benally 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 Shane Benally was last updated on July 22, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months 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.