ARUSHA GUPTA M.D.
NPI 1003007816
Ophthalmology in Silver Spring, MD


Quality Rating: 60 out of 100 score

NPI Status: Active since August 06, 2007

Contact Information

8630 FENTON ST
SUITE 514
SILVER SPRING, MD
ZIP 20910
Phone: (301) 587-1220

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  • Individual
  • Female
  • Years of Experience 18
  • Ophthalmology
  • PECOS Enrolled
  • Accepts Medicare Approved Payment

About ARUSHA GUPTA

Arusha Gupta is a provider established in Silver Spring, Maryland and her medical specialization is Ophthalmology with more than 18 years of experience. The healthcare provider is registered in the NPI registry with number 1003007816 assigned on August 2007. The practitioner's primary taxonomy code is 207W00000X with license number D70515 (MD). The provider is registered as an individual and her NPI record was last updated 12 years ago.

NPI1003007816
Provider NameARUSHA GUPTA M.D.
Location Address8630 FENTON ST SUITE 514 SILVER SPRING, MD 20910
Location Phone(301) 587-1220
Mailing Address8630 FENTON ST SUITE 514 SILVER SPRING, MD 20910
GenderFemale
Entity TypeIndividual
Medical School NameOTHER
Graduation Year2006
Is Sole Proprietor?No
Enumeration Date08-06-2007
Last Update Date11-29-2011
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Ophthalmologists like Arusha Gupta specialize in diagnosing and treating eye conditions. They may perform surgeries to correct vision issues or prevent vision loss due to diseases like glaucoma. Additionally, they can provide eyeglasses, prescribe contact lenses, and offer other vision-related services.

Arusha Gupta 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 60, 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: $38.79 for a new patient copayment and $21.24 for an established patient copayment.

Location Map

Mailing Address

8630 FENTON ST
SUITE 514
SILVER SPRING, MD
ZIP 20910
Phone: (301) 587-1220

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

Ophthalmology

Taxonomy Code207W00000X
TypeAllopathic & Osteopathic Physicians
License No.D70515
License StateMD
Taxonomy DescriptionAn 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.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1207W00000XAllopathic & Osteopathic Physicians

Ophthalmology

245090 (NY)

Insurance Plans Accepted

The NPI profile data suggests this provider may be accepting health plans from these insurance companies or healthcare programs:

  • Medicaid
  • Medicare

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
032987800MEDICAID (05)MD 
182574YYUMEDICARE PIN (08)MD 

PECOS Enrollment and Medicare Participation Status

Arusha Gupta 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: 9638201171

    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: I20120117000238

    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 20910 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99204

  • Average New Patient Price $155.19
  • Minimum New Patient Price $68.56
  • Maximum New Patient Price $204.56
  • Average New Patient Copayment $38.79
  • Minimum New Patient Copayment $17.14
  • Maximum New Patient Copayment $51.14

Established Patients Visit Costs *

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

  • Average Established Patient Price $84.99
  • Minimum Established Patient Price $21.87
  • Maximum Established Patient Price $167.24
  • Average Established Patient Copayment $21.24
  • Minimum Established Patient Copayment $5.46
  • Maximum Established Patient Copayment $41.81

* 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: 60 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: N/A

    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: N/A

    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: N/A

    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.

  • 839

    Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits (HCPCS:92014)

  • 642

    Photography of the retina (HCPCS:92250)

  • 385

    Measurement of field of vision during daylight conditions (HCPCS:92083)

  • 247

    Diagnostic imaging of optic nerve of eye (HCPCS:92133)

  • 223

    Eye and medical examination for diagnosis and treatment, established patient (HCPCS:92012)

  • 133

    Diagnostic imaging of retina (HCPCS:92134)

  • 127

    Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits (HCPCS:92004)

Reviews for ARUSHA GUPTA M.D.

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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.
1003007816
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2003001482
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 + 8 + 2 + 24 = 44
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
50 - 44 = 66

The NPI number 1003007816 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1497751531DR. GARY LUCOMBE DDS
Individual
Dentist (General Practice)8630 FENTON ST STE 204
SILVER SPRING, MD 20910
(301) 587-8081
1912905266DR. PURNIMA SAU M.D.
Individual
Dermatology (Dermatopathology)8630 FENTON ST SUITE 906
SILVER SPRING, MD 20910
(301) 565-3699
1720076904 JOEL M ENGELSTEIN M.D.
Individual
Ophthalmology8630 FENTON ST SUITE 130
SILVER SPRING, MD 20910
(301) 588-1177
1326036401 HAROLD I. RODMAN M.D.
Individual
Ophthalmology8630 FENTON ST SUITE 130
SILVER SPRING, MD 20910
(301) 588-1177
1902879430STEPHEN PARK, D.D.S.
Organization
Dentist (General Practice)8630 FENTON ST #928
SILVER SPRING, MD 20910
(301) 587-2800
1790741759MONTGOMERY INFECTIOUS DISEASE ASSOCIATES,PA
Organization
Internal Medicine (Infectious Disease)8630 FENTON ST SUITE 700
SILVER SPRING, MD 20910
(301) 588-2525
1285683441 JULIE G GUTMARK M.D.
Individual
Ophthalmology8630 FENTON ST SUITE 130
SILVER SPRING, MD 20910
(301) 588-1177
1447289558DR. RANDI JEAN WORTMAN PH.D.
Individual
Psychologist8630 FENTON ST SUITE 320
SILVER SPRING, MD 20910
(301) 661-3302
1467536235MRS. OLUSOLA ADEDEJI MS, RD, LD, LN
Individual
Nutritionist8630 FENTON ST SUITE 934
SILVER SPRING, MD 20910
(301) 588-4440
1497834097 NEGIN MOAZAMI D.D.S.
Individual
Dentist (General Practice)8630 FENTON ST SUITE #902
SILVER SPRING, MD 20910
(301) 589-1143
1164594453HAROLD I. RODMAN, M.D. & JOEL M. ENGELSTEIN. M.D.
Organization
Ophthalmology8630 FENTON ST SUITE 130
SILVER SPRING, MD 20910
(301) 588-1177
1154479657OPTICAL SHOP
Organization
Technician/Technologist (Optician)8630 FENTON ST SUITE 123
SILVER SPRING, MD 20910
(301) 589-7732
1720133705 FRANK TRINH M.D.
Individual
Internal Medicine (Infectious Disease)8630 FENTON ST SUITE 700
SILVER SPRING, MD 20910
(301) 588-3322
1740323369DR. DENISE A TAYLOR SHAW DDS
Individual
Dentist (General Practice)8630 FENTON ST SUITE # 210
SILVER SPRING, MD 20910
(301) 589-8110
1619009198DR. RAYMOND B. VAN GENNIP DDS, MSD
Individual
Dentist (Periodontics)8630 FENTON ST SUITE 212
SILVER SPRING, MD 20910
(301) 565-8030
1194940775DR. MEREDITH DRAPKIN LUNDERGAN MD
Individual
Psychiatry & Neurology (Psychiatry)8630 FENTON ST SUITE 612
SILVER SPRINGS, MD 20910
(301) 585-1703
1063630457TAYLOR AND OSTERMAN, PA
Organization
Podiatrist8630 FENTON ST SUITE 1
SILVER SPRING, MD 20910
(301) 587-5666
1518176254DENISE TAYLOR-SHAW DDS PA
Organization
Dentist8630 FENTON ST SUITE 210
SILVER SPRING, MD 20910
(301) 589-8110
1417154386 PAMELA CRUTCHFIELD R.N.
Individual
Registered Nurse8630 FENTON ST SUITE 222
SILVER SPRING, MD 20910
(301) 565-7890
1184804551DR ROSELYN E EPPS PA
Organization
Specialist8630 FENTON ST SUITE 300
SILVER SPRING, MD 20910
(301) 495-9646

Frequently Asked Questions

What is Arusha Gupta M.D. NPI number?

The NPI number assigned to this healthcare provider is 1003007816, enumerated in the NPI registry as an "individual" on August 06, 2007

Where is the provider located?

The provider is located at 8630 Fenton St Suite 514 Silver Spring, Md 20910 and the phone number is (301) 587-1220

What is the provider specialty code?

The provider's speciality is Ophthalmology with taxonomy code 207W00000X

How many years of experience does Arusha Gupta M.D. have?

The provider has more than 18 years of experience.

What insurance does Arusha Gupta M.D. accept?

The provider might be accepting Medicaid and Medicare. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Is Arusha Gupta M.D. 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.

How much is a visit to Arusha Gupta M.D.?

Medicare beneficiaries should expect a typical cost of $155.19 with an average copayment of $38.79 for new patient appointments. Established patients should expect a typical charge of $84.99 and an average copayment of 21.24. Please review your insurance plan or contact the provider directly to determine your specific costs.

What are some of the services provided by Arusha Gupta M.D.?

The most common procedures or services performed by this practitioner are: Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits, Photography of the retina, Measurement of field of vision during daylight conditions, Diagnostic imaging of optic nerve of eye, Eye and medical examination for diagnosis and treatment, established patient, Diagnostic imaging of retina and Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits.

How do I update my NPI information?

This NPI record was last updated on August 06, 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].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.