KENNETH S SMERKA PA
NPI 1003007782
Physician Assistant in Amherst, NY


Quality Rating: 98.8 out of 100 score

NPI Status: Active since August 07, 2007

Contact Information

4050 HARLEM RD
AMHERST, NY
ZIP 14226
Phone: (716) 803-1504
Fax: (716) 803-1508

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  • Individual
  • Male
  • Years of Experience 17
  • Physician Assistant
  • PECOS Enrolled
  • Accepts Medicare Approved Payment

About KENNETH SMERKA

Kenneth Smerka is a primary care provider established in Amherst, New York and his medical specialization is Physician Assistant with more than 17 years of experience. The healthcare provider is registered in the NPI registry with number 1003007782 assigned on August 2007. The practitioner's primary taxonomy code is 363A00000X with license number 011934 (NY). The provider is registered as an individual and his NPI record was last updated 14 years ago.

NPI1003007782
Provider NameKENNETH S SMERKA PA
Location Address4050 HARLEM RD AMHERST, NY 14226
Location Phone(716) 803-1504
Mailing Address550 ORCHARD PARK RD SUITE A105 WEST SENECA, NY 14224
GenderMale
Entity TypeIndividual
Medical School NameOTHER
Graduation Year2007
Is Sole Proprietor?No
Enumeration Date08-07-2007
Last Update Date06-21-2010
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A primary care provider (PCP) like Kenneth Smerka sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc

Kenneth Smerka is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 98.8, based on four performance areas: quality, improvement activities, promoting interoperability, and cost. The purpose of this information is to help people with Medicare make informed decisions and incentivize doctors and clinicians to maximize performance.

The typical physician office visit costs for Medicare beneficiaries in this area are: $22.01 for a new patient copayment and $17.92 for an established patient copayment.

Location Map

Mailing Address

550 ORCHARD PARK RD
SUITE A105
WEST SENECA, NY
ZIP 14224
Phone: (716) 677-6000
Fax: (716) 677-6006

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Physician Assistant

Taxonomy Code363A00000X
TypePhysician Assistants & Advanced Practice Nursing Providers
License No.011934
License StateNY
Taxonomy DescriptionA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

PECOS Enrollment and Medicare Participation Status

Kenneth Smerka is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • PECOS PAC ID: 446345334

    What is the PECOS Associate Control ID?
    A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

  • PECOS Enrollment ID: I20071008000355

    What is the Provider Enrollment ID?
    The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

  • Accepts Medicare Assignment? Yes

    What does it mean "accepts medicare assignment"?
    When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
    A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): Yes

  • Eligible to Order or Refer Power Mobility Devices: Yes

Physician Visit Costs

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 14226 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

  • Average New Patient Price $88.06
  • Minimum New Patient Price $57.17
  • Maximum New Patient Price $174.05
  • Average New Patient Copayment $22.01
  • Minimum New Patient Copayment $14.29
  • Maximum New Patient Copayment $43.51

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

  • Average Established Patient Price $71.71
  • Minimum Established Patient Price $17.76
  • Maximum Established Patient Price $142.28
  • Average Established Patient Copayment $17.92
  • Minimum Established Patient Copayment $4.44
  • Maximum Established Patient Copayment $35.57

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Overall MIPS Quality Performance

The Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS Quality Payment Program (QPP). The MIPS program affects clinician reimbursement for Part B covered professional services and also rewards them for improving the quality of patient care and outcomes.

  • Final Score: 98.8 out of 100

    The MIPS program evaluates providers across multiple categories with a specific weight for each category resulting a in a MIPS final score that ranges from 0 to 100 points. The MIPS Final Score determines whether providers receive a negative, neutral or positive MIPS payment adjustment.

  • Quality Score: 100

    The Quality category assesses providers performance on clinical practices and patient outcomes under the traditional MIPS program. The quality measures help identify the quality of healthcare processes, outcomes, and patient experiences. The Quality measure category compromises 40% providers final MPIS scores.

    There are six collection types for MIPS quality measures: Electronic Clinical Quality Measures (eCQMs), MIPS Clinical Quality Measures (CQMs), Qualified Clinical Data Registry (QCDR) Measures, Medicare Part B claims measures, CMS Web Interface measures and The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey.

  • Promoting Interoperability Score: 96

    The Interoperability category measures the providers ability to use technology to exchange and make use of healthcare information in a way that is less burdensome and improves outcomes. The Interoperability measure category compromises 25% providers final MPIS scores.

    The MIPS Interoperability measure focuses on the use of certified electronic health record technology (CEHRT) to improve patient access health information, the exchange of information between clinicians and pharmacies and the systematic collection, analysis, and interpretation of healthcare data.

  • Improvement Activities Score: 40

    The Improvement Activities performance category evaluates the providers participation in clinical activities that support the improvement of clinical practice, care delivery, and outcomes. Providers have the option to choose 2 to 4 activities from an inventory of over 100 improvement activities. Providers typically choose the activities that best fit their needs. The improvement activities measure category compromises 15% providers final MPIS scores.

    The Improvement measures aim to better patient engagement, patient safety and other areas of patient care. The Improvement Activities category compromises 15% of providers final MPIS scores.

  • Cost Score: N/A

    The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.

    Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.

  • Cost Score: N/A

    The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.

    Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.

Clinician Services

The following Healthcare Common Procedure Coding System (HCPCS) codes were publicly reported as the top services rendered by this provider under the Medicare program for the year 2017. The reported codes are based on the top 5 codes for each available specialty, excluding evaluation and management codes.

  • 16

    Insertion of central venous catheter for infusion, patient 5 years or older (HCPCS:36556)

  • 12

    Ultrasound guidance for accessing into blood vessel (HCPCS:76937)

Hospital Affiliations

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Kenneth Smerka is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
KENMORE MERCY HOSPITAL2950 ELMWOOD AVENUE
KENMORE, NY 14217
(716) 447-6100Acute Care Hospitals

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1003007782
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
20030014716
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 0 + 0 + 3 + 0 + 0 + 1 + 4 + 7 + 1 + 6 + 24 = 48
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
50 - 48 = 22

The NPI number 1003007782 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 3 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1780600718 LEE GUTERMAN M.D.
Individual
Neurological Surgery4050 HARLEM RD
AMHERST, NY 14226
(716) 803-1504
1386948263BUFFALO NEUROSURGERY P.C.
Organization
Durable Medical Equipment & Medical Supplies4050 HARLEM RD
AMHERST, NY 14226
(716) 803-1504
1396170981CLINICAL NEUROSCIENCE SERVICES MED/SURG PLLC
Organization
Neurological Surgery4050 HARLEM RD
AMHERST, NY 14226
(716) 803-1507

Frequently Asked Questions

What is Kenneth Smerka PA NPI number?

The NPI number assigned to this healthcare provider is 1003007782, enumerated in the NPI registry as an "individual" on August 07, 2007

Where is the provider located?

The provider is located at 4050 Harlem Rd Amherst, Ny 14226 and the phone number is (716) 803-1504

What is the provider specialty code?

The provider's speciality is Physician Assistant with taxonomy code 363A00000X

How many years of experience does Kenneth Smerka PA have?

The provider has more than 17 years of experience.

Is Kenneth Smerka PA registered in PECOS?

Yes, as of February 16, 2024 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What are Kenneth Smerka PA Quality Ratings?

The provider has an overall high rating in the following quality measures: quality clinical practices and patient outcomes and experiences , uses technology to exchange and make use of healthcare information.

How much is a visit to Kenneth Smerka PA?

Medicare beneficiaries should expect a typical cost of $88.06 with an average copayment of $22.01 for new patient appointments. Established patients should expect a typical charge of $71.71 and an average copayment of 17.92. Please review your insurance plan or contact the provider directly to determine your specific costs.

What are some of the services provided by Kenneth Smerka PA?

The most common procedures or services performed by this practitioner are: Insertion of central venous catheter for infusion, patient 5 years or older and Ultrasound guidance for accessing into blood vessel.

Is Kenneth Smerka PA affiliated to any hospitals?

The practitioner is affiliated to the following hospital(s): KENMORE MERCY HOSPITAL. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

How do I update my NPI information?

This NPI record was last updated on August 07, 2007. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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