DR. VIRAL PATEL D.O. NPI 1003012428
Family Medicine in Crittenden, KY
About DR. VIRAL PATEL D.O.
Viral Patel is a primary care provider established in Crittenden, Kentucky and his medical specialization is Family Medicine with more than 19 years of experience. He graduated from University Of Pikeville, Kentucky College Of Osteopathic Med in 2004. The NPI number of this provider is 1003012428 and was assigned on June 2007. The practitioner's primary taxonomy code is 207Q00000X with license number 03024 (KY). The provider is registered as an individual and his NPI record was last updated one year ago.
| NPI | 1003012428 |
| Provider Name | DR. VIRAL PATEL D.O. |
| Location Address | 405 VIOLET RD CRITTENDEN, KY 41030 |
| Location Phone | (859) 428-1610 |
| Mailing Address | PO BOX 635283 CINCINNATI, OH 45263 |
| Gender | Male |
| NPI Entity Type | Individual |
| Medical School Name | UNIVERSITY OF PIKEVILLE, KENTUCKY COLLEGE OF OSTEOPATHIC MED |
| Graduation Year | 2004 |
| Is Sole Proprietor? | No |
| Enumeration Date | 06-22-2007 |
| Last Update Date | 09-23-2021 |
A primary care provider (PCP) like Viral Patel 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 Viral Patel 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.
Viral Patel 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 94.4, 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 following quality measures were reported for this provider: colorectal cancer screening, pneumococcal vaccination status for older adults, preventive care and screening: body mass index (bmi) screening and follow-up plan and preventive care and screening: screening for depression and follow-up plan.
The typical physician office visit costs for Medicare beneficiaries in this area are: $21.18 for a new patient copayment and $24.51 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 | 207Q00000X |
| Classification | Family Medicine |
| Type | Allopathic & Osteopathic Physicians |
| License No. | 03024 |
| License State | KY |
| Taxonomy Description | Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
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
405 VIOLET RD
CRITTENDEN, KY
ZIP 41030
Phone: (859) 428-1610
Fax: (859) 428-3923
Mailing Address
PO BOX 635283
CINCINNATI, OH
ZIP 45263
Phone: (859) 428-1610
Fax: (859) 428-3923
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 | 8325148158 |
| PECOS Enrollment ID | I20070710000284 |
| 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 41030 ZIP code area.
| New Patients Office Visits Costs * | ||
|---|---|---|
| Most Utilized Procedure Code for new patients office visits: 99203 | ||
| Minimum New Patient Pricing | Maximum New Patient Pricing | Typical New Patient Pricing |
| $54.72 | $168.41 | $84.75 |
| Minimum New Patient Copayment | Maximum New Patient Copayment | Typical New Patient Copayment |
| $13.68 | $42.1 | $21.18 |
| 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 |
| $16.65 | $137.34 | $98.06 |
| Minimum Established Patient Copayment | Maximum Established Patient Copayment | Typical Established Patient Copayment |
| $4.16 | $34.33 | $24.51 |
* 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% | 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. |
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| Promoting Interoperability (PI) | 25% | 81.4 | |
|
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% | 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 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 | - | 94.4 | |
| 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 Reporting
The following quality measures meet Medicare's statistical reporting standards for the year 2018. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Colorectal Cancer Screening | 78% | 209 |
| Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer | ||
| Pneumococcal Vaccination Status for Older Adults | 87% | 211 |
| Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine | ||
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | 19% | 308 |
| Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2 | ||
| Preventive Care and Screening: Screening for Depression and Follow-Up Plan | 54% | 226 |
| Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen | ||
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.
- 298Insertion of needle into vein for collection of blood sample (HCPCS:36415)
- 178Injection beneath the skin or into muscle for therapy, diagnosis, or prevention (HCPCS:96372)
- 95Administration of influenza virus vaccine (HCPCS:G0008)
- 67Automated urinalysis test (HCPCS:81003)
- 27Routine EKG using at least 12 leads including interpretation and report (HCPCS:93000)
- 24Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imple (HCPCS:G0180)
- 15Administration of pneumococcal vaccine (HCPCS:G0009)
- 12Pneumococcal vaccine for injection into muscle (HCPCS:90670)
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 |
|---|---|---|
| 2769277 | MEDICAID (05) | OH |
| 7100013990 | MEDICAID (05) | KY |
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 | 2 | 4 | 2 | 8 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 0 | 0 | 3 | 0 | 1 | 4 | 4 | 4 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 0 + 0 + 3 + 0 + 1 + 4 + 4 + 4 + 24 = 42 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 50 - 42 = 8 | 8 | ||||||||
The NPI number 1003012428 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 10 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1356446447 | DR. PHILLIP LEE KISER M.D. Individual | Family Medicine | 405 VIOLET RD CRITTENDEN, KY 41030 (859) 903-0268 |
| 1891197273 | RYAN FREIBERT D.O. Individual | Neuromusculoskeletal Medicine & OMM | 405 VIOLET RD CRITTENDEN, KY 41030 (859) 428-1610 |
| 1063895522 | NICOLE ABBOT MD Individual | Psychiatry & Neurology (Psychiatry) | 405 VIOLET RD CRITTENDEN, KY 41030 (859) 301-5901 |
| 1053967653 | AVERY JEA MARTIN Individual | Nurse Practitioner | 405 VIOLET RD CRITTENDEN, KY 41030 (859) 428-1610 |
| 1891285938 | HEALTHPOINT FAMILY CARE, INC. Organization | Clinic/Center (Federally Qualified Health Center (FQHC)) | 405 VIOLET RD CRITTENDEN, KY 41030 (859) 655-6100 |
| 1518989334 | DR. KATHIE E MORGAN MD Individual | Family Medicine | 405 VIOLET RD CRITTENDEN, KY 41030 (859) 428-1610 |
| 1942261250 | DR. BRADFORD ALAN QUATKEMEYER MD Individual | Family Medicine | 405 VIOLET RD CRITTENDEN, KY 41030 (859) 428-1610 |
| 1750899142 | WILLIAM TRAVIS YOUNG ARNP, FNP-C Individual | Nurse Practitioner | 405 VIOLET RD CRITTENDEN, KY 41030 (859) 903-0268 |
| 1366539652 | MRS. SUZANNE MICHELLE FERNBACH PA-C Individual | Physician Assistant | 405 VIOLET RD CRITTENDEN, KY 41030 (859) 903-0268 |
| 1952415788 | OSCAR O PEREZ JR. DO Individual | Family Medicine | 405 VIOLET RD CRITTENDEN, KY 41030 (859) 903-0268 |
Frequently Asked Questions
What is Dr. Viral Patel D.O. NPI number?
The NPI number assigned to this healthcare provider is 1003012428, registered as an "individual" on June 22, 2007
Where is Dr. Viral Patel D.O. located?
The provider is located at 405 Violet Rd Crittenden, Ky 41030 and the phone number is (859) 428-1610
Which is Dr. Viral Patel D.O. specialty?
The provider's speciality is Family Medicine
How many years of experience does Dr. Viral Patel D.O. have?
The provider has more than 19 years of experience. He graduated from University Of Pikeville, Kentucky College Of Osteopathic Med in 2004.
What insurance does Dr. Viral Patel D.O. 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. Viral Patel D.O. 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. Viral Patel D.O. 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 Dr. Viral Patel D.O.?
Medicare beneficiaries should expect a typical cost of $84.75 with an average copayment of $21.18 for new patient appointments. Established patients should expect a typical charge of $98.06 and an average copayment of 24.51. Please review your insurance plan or contact the provider directly to determine your specific costs.
What are some of the services provided by Dr. Viral Patel D.O.?
The most common procedures or services performed by this practitioner are: Insertion of needle into vein for collection of blood sample, Injection beneath the skin or into muscle for therapy, diagnosis, or prevention, Administration of influenza virus vaccine, Automated urinalysis test, Routine EKG using at least 12 leads including interpretation and report, Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imple, Administration of pneumococcal vaccine and Pneumococcal vaccine for injection into muscle.
How do I update my NPI information?
The NPI record of Dr. Viral Patel D.O. was last updated on June 22, 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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