DR. ETAN B SPIRA M.D. NPI 1003011891
Internal Medicine - Gastroenterology in Belleville, NJ
About DR. ETAN B SPIRA M.D.
Etan Spira is an internist established in Belleville, New Jersey and his medical specialization is Internal Medicine with a focus in gastroenterology with more than 16 years of experience. He graduated from New York University School Of Medicine in 2007. The NPI number of this provider is 1003011891 and was assigned on June 2007. The practitioner's primary taxonomy code is 207RG0100X with license number 25MA09471300 (NJ). The provider is registered as an individual and his NPI record was last updated 8 years ago.
| NPI | 1003011891 |
| Provider Name | DR. ETAN B SPIRA M.D. |
| Location Address | 5 FRANKLIN AVE SUITE 109 BELLEVILLE, NJ 07109 |
| Location Phone | (973) 759-7240 |
| Mailing Address | 5 FRANKLIN AVE SUITE 109 BELLEVILLE, NJ 07109 |
| Gender | Male |
| NPI Entity Type | Individual |
| Medical School Name | NEW YORK UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 2007 |
| Is Sole Proprietor? | No |
| Enumeration Date | 06-20-2007 |
| Last Update Date | 02-13-2015 |
An internist like Etan Spira is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.Etan Spira 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.
Etan Spira is registered with Medicare and accepts claims assignment, this means the provider accepts Medicare's approved amount for the cost of rendered services as full payment. Participating providers may not charge Medicare beneficiaries more than Medicare's approved amount for their services. Medicare beneficiaries still have to pay a coinsurance or copayment amount for a visit or service. According to Medicare claims data he has hospital affiliations with .
The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 45, 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 provider also has detailed performance information the following quality measures: clinical data registry reporting, depression screening, engagement of patients through implementation of improvements in patient portal, e-prescribing, implementation of fall screening and assessment programs, implementation of medication management practice improvements, provide patients electronic access to their health information, public health registry reporting, security risk analysis, tobacco use and use of decision support and standardized treatment protocols.
The typical physician office visit costs for Medicare beneficiaries in this area are: $37.64 for a new patient copayment and $29.21 for an established patient copayment.
Primary Taxonomy
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
| Taxonomy Code | 207RG0100X |
| Classification | Internal Medicine |
| Type | Allopathic & Osteopathic Physicians |
| Specialization | Gastroenterology |
| License No. | 25MA09471300 |
| License State | NJ |
| Taxonomy Description | An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
Accepted Insurance
The NPI profile data indicates this provider might be enrolled and accepting health plans from the following insurance companies or healthcare programs:
- Medicaid
- Medicare
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Business Address
5 FRANKLIN AVE
SUITE 109
BELLEVILLE, NJ
ZIP 07109
Phone: (973) 759-7240
Fax: (973) 759-7243
Mailing Address
5 FRANKLIN AVE
SUITE 109
BELLEVILLE, NJ
ZIP 07109
Phone: (973) 759-7240
Fax: (973) 759-7243
Location Map
PECOS Enrollment and Medicare Participation Status
What is PECOS?
PECOS is the Medicare Provider, Enrollment, Chain and Ownership System. PECOS is Medicare's enrollment and revalidation system and it is the primary source of information about verified Medicare professionals. A NPI number is necessary to register in PECOS. Providers must enroll in PECOS to avoid denied claims.
| Registered in PECOS? | Yes |
| PECOS PAC ID | 4587858543 |
| PECOS Enrollment ID | I20140813000143 |
| 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 order / refer Part B Clinical Laboratory and Imaging | Yes |
| Eligible order / refer Durable Medical Equipment | Yes |
| Eligible order / refer Home Health Agency (HHA) | Yes |
| Eligible order / refer Power Mobility Devices | Yes |
Physician Office Visit Costs
The provider accepts as payment the Medicare approved amount. Medicare beneficiaries should not be billed for more than the Medicare deductible and coinsurance amounts. Medicare pricing is usually a reference point for private insurance covered patients. The prices below reflect the costs for new and established patients in the 07109 ZIP code area.
| New Patients Office Visits Costs * | ||
|---|---|---|
| Most Utilized Procedure Code for new patients office visits: 99204 | ||
| Minimum New Patient Pricing | Maximum New Patient Pricing | Typical New Patient Pricing |
| $66.45 | $198.48 | $150.56 |
| Minimum New Patient Copayment | Maximum New Patient Copayment | Typical New Patient Copayment |
| $16.61 | $49.62 | $37.64 |
| Established Patients Office Visits Costs * | ||
|---|---|---|
| Most Utilized Procedure Code for established patients office visits: 99214 | ||
| Minimum Established Patient Pricing | Maximum Established Patient Pricing | Typical Established Patient Pricing |
| $21.27 | $162.58 | $116.86 |
| Minimum Established Patient Copayment | Maximum Established Patient Copayment | Typical Established Patient Copayment |
| $5.31 | $40.64 | $29.21 |
* The physician office visit costs information is obtained by Medicare's 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 Medicare's 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.
| MIPS Measure | Score Weight | Score | |
|---|---|---|---|
| Quality | 40% | 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. |
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| Promoting Interoperability (PI) | 25% | 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. |
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| Improvement Activities | 15% | 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 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. |
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| Cost | 20% | 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. |
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| MIPS Final Score | - | 45 | |
| 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. | |||
MIPS Quality Measures
The following performance measures were reported under the Merit-Based Incentive Payment System (MIPS) and Qualified Clinical Data Registry (QCDR) quality measures program.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Clinical Data Registry Reporting | Yes | N/A |
| The MIPS eligible clinician is in active engagement to submit data to a clinical data registry. | ||
| Depression screening | Yes | N/A |
| Depression screening and follow-up plan: Regular engagement of MIPS eligible clinicians or groups in integrated prevention and treatment interventions, including depression screening and follow-up plan (refer to NQF #0418) for patients with co-occurring conditions of behavioral or mental health conditions. | ||
| Engagement of patients through implementation of improvements in patient portal | Yes | N/A |
| Access to an enhanced patient portal that provides up to date information related to relevant chronic disease health or blood pressure control, and includes interactive features allowing patients to enter health information and/or enables bidirectional communication about medication changes and adherence. | ||
| e-Prescribing | 98% | 241 |
| At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using CEHRT. | ||
| Implementation of fall screening and assessment programs | Yes | N/A |
| Implementation of fall screening and assessment programs to identify patients at risk for falls and address modifiable risk factors (e.g., Clinical decision support/prompts in the electronic health record that help manage the use of medications, such as benzodiazepines, that increase fall risk). | ||
| Implementation of medication management practice improvements | Yes | N/A |
| Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following:Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups;Integrate a pharmacist into the care team; and/orConduct periodic, structured medication reviews. | ||
| Provide Patients Electronic Access to Their Health Information | 72% | 315 |
| For at least one unique patient seen by the MIPS eligible clinician: (1) The patient (or the patient-authorized representative) is provided timely access to view online, download, and transmit his or her health information; and (2) The MIPS eligible clinician ensures the patient's health information is available for the patient (or patient-authorized representative) to access using any application of their choice that is configured to meet the technical specifications of the Application Programing Interface (API) in the MIPS eligible clinician's certified electronic health record technology (CEHRT). | ||
| Public Health Registry Reporting | Yes | N/A |
| The MIPS eligible clinician is in active engagement with a public health agency to submit data to public health registries. | ||
| Security Risk Analysis | Yes | N/A |
| Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified electronic health record technology (CEHRT) in accordance with requirements in 45 CFR 164.312(a)(2)(iv) and 164.306(d)(3), implement security updates as necessary, and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process. | ||
| Tobacco use | Yes | N/A |
| Tobacco use: Regular engagement of MIPS eligible clinicians or groups in integrated prevention and treatment interventions, including tobacco use screening and cessation interventions (refer to NQF #0028) for patients with co-occurring conditions of behavioral or mental health and at risk factors for tobacco dependence. | ||
| Use of decision support and standardized treatment protocols | Yes | N/A |
| Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs. | ||
Clinician Utilization
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 Medicare specialty, excluding evaluation and management codes.
- 51Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope (HCPCS:43239)
- 36Biopsy of large bowel using an endoscope (HCPCS:45380)
- 34Removal of polyps or growths of large bowel using an endoscope (HCPCS:45385)
- 16Diagnostic examination of large bowel using an endoscope (HCPCS:45378)
- 15Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope (HCPCS:43235)
Additional Identifiers
Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State |
|---|---|---|
| 3587443UFU | MEDICARE PIN (08) | NJ |
| 0415588 | MEDICAID (05) | NJ |
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. | |||||||||
| 1 | 0 | 0 | 3 | 0 | 1 | 1 | 8 | 9 | 1 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 0 | 0 | 3 | 0 | 1 | 2 | 8 | 18 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 0 + 0 + 3 + 0 + 1 + 2 + 8 + 1 + 8 + 24 = 49 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 50 - 49 = 1 | 1 | ||||||||
The NPI number 1003011891 is valid because the calculated check digit 1 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 |
|---|---|---|---|
| 1649266578 | DR. HOWARD P PRUZON M.D. Individual | Ophthalmology | 5 FRANKLIN AVE SUITE 209 BELLEVILLE, NJ 07109 (973) 751-6060 |
| 1568418010 | ARTHRITIS MANAGEMENT, L.L.C Organization | Specialist | 5 FRANKLIN AVE SUITE 403 BELLEVILLE, NJ 07109 (973) 844-0049 |
| 1932112133 | DEBORAH GRACE SCHNURR MD Individual | Internal Medicine | 5 FRANKLIN AVE STE 410 BELLEVILLE, NJ 07109 (973) 751-6610 |
| 1073625117 | PENNY E DEFRANCO M.D. Individual | Internal Medicine (Nephrology) | 5 FRANKLIN AVE SUITE 401 BELLEVILLE, NJ 07109 (973) 450-8999 |
| 1962514018 | RANKA SAMSA M.D. Individual | Internal Medicine (Nephrology) | 5 FRANKLIN AVE SUITE 401 BELLEVILLE, NJ 07109 (973) 450-8999 |
| 1851403927 | SOUTH MOUNTAIN NEPHROLOGY, LLC Organization | Internal Medicine (Nephrology) | 5 FRANKLIN AVE SUITE 401 BELLEVILLE, NJ 07109 (973) 450-8999 |
| 1891884482 | WILLIAM ANTHONY CHRISTIANA MD Individual | Internal Medicine | 5 FRANKLIN AVE SUITE 609 BELLEVILLE, NJ 07109 (973) 751-1410 |
| 1982794707 | MICHAEL JOSEPH MILLER MD Individual | Internal Medicine | 5 FRANKLIN AVE SUITE 609 BELLEVILLE, NJ 07109 (973) 751-1410 |
| 1386724672 | DR. RAMA REDDY MD Individual | Specialist | 5 FRANKLIN AVE #609 BELLEVILLE, NJ 07109 (973) 759-1111 |
| 1205915634 | DR. ROBYN MEGLIO MD Individual | Obstetrics & Gynecology | 5 FRANKLIN AVE SUITE # 310 BELLEVILLE, NJ 07109 (973) 759-4090 |
| 1437227600 | DR. EDWIN A AMIRATA M.D. Individual | Surgery | 5 FRANKLIN AVE SUITE 406 BELLEVILLE, NJ 07109 (973) 759-4499 |
| 1710055918 | AMIRATA SURGICAL ASSOCIATES Organization | Surgery | 5 FRANKLIN AVE SUITE 406 BELLEVILLE, NJ 07109 (973) 759-4499 |
| 1932277118 | DR. ROBERT A BRAUTIGAN M.D., Individual | Surgery | 5 FRANKLIN AVE SUITE 406 BELLEVILLE, NJ 07109 (973) 759-4499 |
| 1699828368 | MRS. DIANELLA R SISON CRNA Individual | Nurse Anesthetist, Certified Registered | 5 FRANKLIN AVE SUITE 209 BELLEVILLE, NJ 07109 (973) 751-6060 |
| 1275749814 | OLGA KOSOY PA-C Individual | Physician Assistant | 5 FRANKLIN AVE SUITE 401 BELLEVILLE, NJ 07109 (973) 450-8999 |
| 1578743431 | INTERVENTIONAL PAIN CONSULTANTS OF NEW JERSEY, PA Organization | Pain Medicine (Interventional Pain Medicine) | 5 FRANKLIN AVE SUITE 110 BELLEVILLE, NJ 07109 (973) 779-7354 |
| 1518120518 | JAHIR C. SAMA MD Organization | Clinic/Center (Medical Specialty) | 5 FRANKLIN AVE SUITE 404 BELLEVILLE, NJ 07109 (973) 844-0060 |
| 1780998583 | MEDICAL & SURGICAL EAR NOSE &THROAT GROUP PA Organization | Otolaryngology | 5 FRANKLIN AVE #305 BELLEVILLE, NJ 07109 (973) 759-4005 |
| 1396050548 | ABC SURGICAL ASSOCIATES LLC Organization | Surgery | 5 FRANKLIN AVE SUITE 406 BELLEVILLE, NJ 07109 (973) 759-4490 |
| 1619255387 | DR. KASSEM A FARHAT DDS Individual | Dentist | 5 FRANKLIN AVE SUITE 108 BELLEVILLE, NJ 07109 (973) 751-6600 |
Frequently Asked Questions
What is Dr. Etan Spira M.D. NPI number?
The NPI number assigned to this healthcare provider is 1003011891, registered as an "individual" on June 20, 2007
Where is Dr. Etan Spira M.D. located?
The provider is located at 5 Franklin Ave Suite 109 Belleville, Nj 07109 and the phone number is (973) 759-7240
Which is Dr. Etan Spira M.D. specialty?
The provider's speciality is Internal Medicine with a focus in Gastroenterology
How many years of experience does Dr. Etan Spira M.D. have?
The provider has more than 16 years of experience. He graduated from New York University School Of Medicine in 2007.
What insurance does Dr. Etan Spira 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 Dr. Etan Spira M.D. registered in PECOS?
Yes, as of March 13, 2023 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a Medicare 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 Dr. Etan Spira M.D. Quality Ratings?
The provider obtained a high score in the following performance measures: e-Prescribing. The quality ratings are based on unbiased reviews and reported submissions to Medicare's Quality Payment Program.
How much is a visit to Dr. Etan Spira M.D.?
Medicare beneficiaries should expect a typical cost of $150.56 with an average copayment of $37.64 for new patient appointments. Established patients should expect a typical charge of $116.86 and an average copayment of 29.21. Please review your insurance plan or contact the provider directly to determine your specific costs.
What are some of the services provided by Dr. Etan Spira M.D.?
The most common procedures or services performed by this practitioner are: Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope, Biopsy of large bowel using an endoscope, Removal of polyps or growths of large bowel using an endoscope, Diagnostic examination of large bowel using an endoscope and Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope.
How do I update my NPI information?
The NPI record of Dr. Etan Spira M.D. was last updated on June 20, 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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