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DR. JACK DERBY OD
NPI 1841671948
Optometrist in Marion, IN

Active since June 15, 2015PECOS EnrolledAccepts Medicare Assignment
506 S WASHINGTON ST, MARION, IN 46953(765) 662-6648(765) 662-6250 Get Directions Write a Review

NPPES record last updated: June 15, 2015. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Jack Derby Od NPPES

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

DR. JACK DERBY OD (NPI 1841671948) is an individual optometrist in Marion, Indiana, licensed in Indiana (18003896A) and active in the NPI registry since June 2015. He is enrolled in Medicare PECOS and is a graduate of Indiana University - School Of Optometry (2015).

NPPES Registry Identity

NPI1841671948
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameDR. JACK DERBYCredential: OD
Location Address506 S WASHINGTON STMarion, IN 46953-1961
Mailing Address506 S Washington StMarion, IN 46953-1961 · (765) 662-6648 · Fax (765) 662-6250
Phone(765) 662-6648
Fax(765) 662-6250
Sole ProprietorNo
Medical School CMSIndiana University - School Of OptometryGraduated 2015
Enumeration DateJune 15, 2015
✔ NPI 1841671948 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 IN · 18003896A
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.
506 S WASHINGTON ST, Marion, IN 46953
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health 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. Jack Derby 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 ID5991019382
PECOS Enrollment IDI20150729008368
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 8

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 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.
199 services177 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.
68 services49 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.
37 services37 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.
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).
32 services28 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.
28 services27 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46953 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
$122.49 typical visit price
range $53.07 – $161.76
Typical copayment $30.62 (range $13.26 – $40.44)
Most-billed visit code 99204
Established Patient
$66.48 typical visit price
range $16.93 – $132.22
Typical copayment $16.62 (range $4.23 – $33.05)
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.

Reported Quality Measures

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%38 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 2

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

DEREK PRICE OD
Optometrist
506 S WASHINGTON ST
MARION, IN 46953
Grant County (765) 662-6648
MRS. ASHLEY NICOLE YEARLING O.D.
Optometrist
506 S WASHINGTON ST
MARION, IN 46953
Grant County (765) 662-6648

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 Jack Derby's NPI number?

The NPI number for Jack Derby is 1841671948. It was assigned to this individual provider in the NPPES registry on June 15, 2015.

Where is Jack Derby located?

Jack Derby practices at 506 S Washington St, Marion, IN 46953. The listed phone number is (765) 662-6648.

What is Jack Derby's specialty?

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

Is Jack Derby enrolled in Medicare?

Yes. Jack Derby 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 Jack Derby accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, CareSource and Providence Health Plan list Jack Derby 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 Jack Derby was last updated on June 15, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.