DR. ETAN B SPIRA M.D.
NPI 1003011891
Internal Medicine - Gastroenterology in Belleville, NJ


Quality Rating: 82.73 out of 100 score

NPI Status: Active since June 20, 2007

Contact Information

5 FRANKLIN AVE
SUITE 109
BELLEVILLE, NJ
ZIP 07109
Phone: (973) 759-7240
Fax: (973) 759-7243

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  • Individual
  • Male
  • Years of Experience 17
  • Internal Medicine
  • Gastroenterology
  • PECOS Enrolled
  • Accepts Medicare Approved Payment

About ETAN SPIRA

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 17 years of experience. He graduated from New York University School Of Medicine in 2007. The healthcare provider is registered in the NPI registry with number 1003011891 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 9 years ago.

NPI1003011891
Provider NameDR. ETAN B SPIRA M.D.
Location Address5 FRANKLIN AVE SUITE 109 BELLEVILLE, NJ 07109
Location Phone(973) 759-7240
Mailing Address5 FRANKLIN AVE SUITE 109 BELLEVILLE, NJ 07109
GenderMale
Entity TypeIndividual
Medical School NameNEW YORK UNIVERSITY SCHOOL OF MEDICINE
Graduation Year2007
Is Sole Proprietor?No
Enumeration Date06-20-2007
Last Update Date02-13-2015
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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 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 82.73, 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: $37.64 for a new patient copayment and $29.21 for an established patient copayment.

Location Map

Mailing Address

5 FRANKLIN AVE
SUITE 109
BELLEVILLE, NJ
ZIP 07109
Phone: (973) 759-7240
Fax: (973) 759-7243

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

Internal Medicine Gastroenterology

Taxonomy Code207RG0100X
TypeAllopathic & Osteopathic Physicians
License No.25MA09471300
License StateNJ
Taxonomy DescriptionAn 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.

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
3587443UFUMEDICARE PIN (08)NJ 
0415588MEDICAID (05)NJ 

PECOS Enrollment and Medicare Participation Status

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.

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: 4587858543

    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: I20140813000143

    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 07109 ZIP code area.

New Patients Visit Costs *

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

  • Average New Patient Price $150.56
  • Minimum New Patient Price $66.45
  • Maximum New Patient Price $198.48
  • Average New Patient Copayment $37.64
  • Minimum New Patient Copayment $16.61
  • Maximum New Patient Copayment $49.62

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

  • Average Established Patient Price $116.86
  • Minimum Established Patient Price $21.27
  • Maximum Established Patient Price $162.58
  • Average Established Patient Copayment $29.21
  • Minimum Established Patient Copayment $5.31
  • Maximum Established Patient Copayment $40.64

* 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: 82.73 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: 79.69

    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: 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.

  • 29

    Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope (HCPCS:43239)

  • 13

    Removal of polyps or growths of large bowel using an endoscope (HCPCS:45385)

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. Etan Spira is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
CLARA MAASS MEDICAL CENTERONE CLARA MAASS DRIVE
BELLEVILLE, NJ 7109
(973) 450-2000Acute Care Hospitals
JERSEY CITY MEDICAL CENTER355 GRAND STREET
JERSEY CITY, NJ 7302
(201) 915-2000Acute Care Hospitals

Reviews for DR. ETAN B SPIRA 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.
1003011891
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2003012818
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 = 11

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
1649266578DR. HOWARD P PRUZON M.D.
Individual
Ophthalmology5 FRANKLIN AVE SUITE 209
BELLEVILLE, NJ 07109
(973) 751-6060
1568418010ARTHRITIS MANAGEMENT, L.L.C
Organization
Specialist5 FRANKLIN AVE SUITE 403
BELLEVILLE, NJ 07109
(973) 844-0049
1932112133 DEBORAH GRACE SCHNURR MD
Individual
Internal Medicine5 FRANKLIN AVE STE 410
BELLEVILLE, NJ 07109
(973) 751-6610
1962514018 RANKA SAMSA M.D.
Individual
Internal Medicine (Nephrology)5 FRANKLIN AVE SUITE 401
BELLEVILLE, NJ 07109
(973) 450-8999
1851403927SOUTH 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 Medicine5 FRANKLIN AVE SUITE 609
BELLEVILLE, NJ 07109
(973) 751-1410
1982794707 MICHAEL JOSEPH MILLER MD
Individual
Internal Medicine5 FRANKLIN AVE SUITE 609
BELLEVILLE, NJ 07109
(973) 751-1410
1386724672DR. RAMA REDDY MD
Individual
Specialist5 FRANKLIN AVE #609
BELLEVILLE, NJ 07109
(973) 759-1111
1205915634DR. ROBYN MEGLIO MD
Individual
Obstetrics & Gynecology5 FRANKLIN AVE SUITE # 310
BELLEVILLE, NJ 07109
(973) 759-4090
1437227600DR. EDWIN A AMIRATA M.D.
Individual
Surgery5 FRANKLIN AVE SUITE 406
BELLEVILLE, NJ 07109
(973) 759-4499
1710055918AMIRATA SURGICAL ASSOCIATES
Organization
Surgery5 FRANKLIN AVE SUITE 406
BELLEVILLE, NJ 07109
(973) 759-4499
1932277118DR. ROBERT A BRAUTIGAN M.D.,
Individual
Surgery5 FRANKLIN AVE SUITE 406
BELLEVILLE, NJ 07109
(973) 759-4499
1699828368MRS. DIANELLA R SISON CRNA
Individual
Nurse Anesthetist, Certified Registered5 FRANKLIN AVE SUITE 209
BELLEVILLE, NJ 07109
(973) 751-6060
1275749814 OLGA KOSOY PA-C
Individual
Physician Assistant5 FRANKLIN AVE SUITE 401
BELLEVILLE, NJ 07109
(973) 450-8999
1578743431INTERVENTIONAL PAIN CONSULTANTS OF NEW JERSEY, PA
Organization
Pain Medicine (Interventional Pain Medicine)5 FRANKLIN AVE SUITE 110
BELLEVILLE, NJ 07109
(973) 779-7354
1518120518JAHIR C. SAMA MD
Organization
Clinic/Center (Medical Specialty)5 FRANKLIN AVE SUITE 404
BELLEVILLE, NJ 07109
(973) 844-0060
1780998583MEDICAL & SURGICAL EAR NOSE &THROAT GROUP PA
Organization
Otolaryngology5 FRANKLIN AVE #305
BELLEVILLE, NJ 07109
(973) 759-4005
1396050548ABC SURGICAL ASSOCIATES LLC
Organization
Surgery5 FRANKLIN AVE SUITE 406
BELLEVILLE, NJ 07109
(973) 759-4490
1619255387DR. KASSEM A FARHAT DDS
Individual
Dentist5 FRANKLIN AVE SUITE 108
BELLEVILLE, NJ 07109
(973) 751-6600
1184902850DR. ELIZABETH LLAMERA DDS
Individual
Dentist5 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, enumerated in the NPI registry as an "individual" on June 20, 2007

Where is the provider located?

The provider is located at 5 Franklin Ave Suite 109 Belleville, Nj 07109 and the phone number is (973) 759-7240

What is the provider specialty code?

The provider's speciality is Internal Medicine with taxonomy code 207RG0100X with a focus in Gastroenterology

How many years of experience does Dr. Etan Spira M.D. have?

The provider has more than 17 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 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 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 and Removal of polyps or growths of large bowel using an endoscope.

Is Dr. Etan Spira M.D. affiliated to any hospitals?

The practitioner is affiliated to the following hospital(s): CLARA MAASS MEDICAL CENTER and JERSEY CITY MEDICAL CENTER. 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 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].
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.