DR. VIRAL PATEL D.O.
NPI 1003012428
Family Medicine in Crittenden, KY


Quality Rating: 95.55 out of 100 score

NPI Status: Active since June 22, 2007

Contact Information

405 VIOLET RD
CRITTENDEN, KY
ZIP 41030
Phone: (859) 428-1610
Fax: (859) 428-3923

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  • Individual
  • Male
  • Years of Experience 20
  • Family Medicine
  • PECOS Enrolled
  • Accepts Medicare Approved Payment
  • Medicare Quality Reporting

About VIRAL PATEL

Viral Patel is a primary care provider established in Crittenden, Kentucky and his medical specialization is Family Medicine with more than 20 years of experience. He graduated from University Of Pikeville, Kentucky College Of Osteopathic Med in 2004. The healthcare provider is registered in the NPI registry with number 1003012428 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 3 years ago.

NPI
1003012428
Provider Name
DR. VIRAL PATEL D.O.
Gender
Male
Entity Type
Individual
Location Address
405 VIOLET RD CRITTENDEN, KY 41030
Location Phone
(859) 428-1610
Location Fax
(859) 428-3923
Mailing Address
PO BOX 635283 CINCINNATI, OH 45263
Mailing Phone
(859) 428-1610
Mailing Fax
(859) 428-3923
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
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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 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 95.55, 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.

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

Family Medicine

Taxonomy Code
207Q00000X
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.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Ambetter from Buckeye Health Plan

    • Choice Bronze HSA - HMO
    • Choice Bronze HSA + Vision + Adult Dental - HMO
    • Clear Gold - HMO
    • Clear Gold + Vision + Adult Dental - HMO
    • Clear Silver - HMO
    • Clear Silver + Vision + Adult Dental - HMO
    • Complete Gold - HMO
    • Complete Gold + Vision + Adult Dental - HMO
    • Complete Silver - HMO
    • Complete Silver + Vision + Adult Dental - HMO
  • Ambetter from Home State Health

    • Choice Bronze HSA - EPO
    • Choice Bronze HSA + Vision + Adult Dental - EPO
    • Clear Gold - EPO
    • Clear Gold + Vision + Adult Dental - EPO
    • Clear Silver - EPO
    • Clear Silver + Vision + Adult Dental - EPO
    • Complete Gold - EPO
    • Complete Gold + Vision + Adult Dental - EPO
    • Complete Silver - EPO
    • Complete Silver + Vision + Adult Dental - EPO
  • Ambetter from MHS

    • Choice Bronze HSA - EPO
    • Choice Bronze HSA + Vision + Adult Dental - EPO
    • Clear Silver - EPO
    • Clear Silver + Vision + Adult Dental - EPO
    • Complete Gold - EPO
    • Complete Gold + Vision + Adult Dental - EPO
    • Complete Silver - EPO
    • Complete Silver + Vision + Adult Dental - EPO
    • Elite Bronze - EPO
    • Elite Bronze + Vision + Adult Dental - EPO
  • Ambetter of Illinois

    • Central Bronze - HMO
    • Central Bronze + Vision + Adult Dental - HMO
    • Central Gold - HMO
    • Central Gold + Vision + Adult Dental - HMO
    • Central Silver - HMO
    • Central Silver + Vision + Adult Dental - HMO
    • Clear Silver - HMO
    • Clear Silver + Vision + Adult Dental - HMO
    • Complete Gold - HMO
    • Complete Gold + Vision + Adult Dental - HMO
  • Ambetter of Tennessee

    • Choice Bronze HSA - EPO
    • Choice Bronze HSA + Vision + Adult Dental - EPO
    • Clear Silver - EPO
    • Clear Silver + Vision + Adult Dental - EPO
    • Complete Gold - EPO
    • Complete Gold + Vision + Adult Dental - EPO
    • Complete Silver - EPO
    • Complete Silver + Vision + Adult Dental - EPO
    • Elite Bronze - EPO
    • Elite Bronze + Vision + Adult Dental - EPO
  • CareSource

    • CareSource Marketplace Bronze First - HMO
    • CareSource Marketplace Bronze First Dental, Vision, & Fitness - HMO
    • CareSource Marketplace Core Gold - HMO
    • CareSource Marketplace Core Gold Dental, Vision, & Fitness - HMO
    • CareSource Marketplace Core Silver - HMO
    • CareSource Marketplace Core Silver Dental, Vision, & Fitness - HMO
    • CareSource Marketplace Diabetes Gold - HMO
    • CareSource Marketplace Diabetes Gold Dental, Vision, & Fitness - HMO
    • CareSource Marketplace Diabetes Silver - HMO
    • CareSource Marketplace Diabetes Silver Dental, Vision, & Fitness - HMO
  • Medicare

  • Medicaid


*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
2769277MEDICAID (05)OH 
7100013990MEDICAID (05)KY 

PECOS Enrollment and Medicare Participation Status

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.

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: 8325148158

    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: I20070710000284

    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

Provider Referred Orders for Durable Medical Equipment, Devices & Supplies

The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.

Durable Medical Equipment

  • Other DME (D1E)

    Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (HCPCS:A4253)

    7 DME suppliers used 45 Medicare Claims 90 Services Paid

  • Other DME (D1E)

    Lancets, per box of 100 (HCPCS:A4259)

    5 DME suppliers used 22 Medicare Claims 25 Services Paid

  • Oxygen and supplies (D1C)

    Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing (HCPCS:E0431)

    2 DME suppliers used 15 Medicare Claims 15 Services Paid

  • Oxygen and supplies (D1C)

    Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)

    3 DME suppliers used 24 Medicare Claims 24 Services Paid

  • Drugs Administered through DME (D1G)

    Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme (HCPCS:J7620)

    3 DME suppliers used 16 Medicare Claims 1730 Services Paid

Drugs and Nutritional Products

  • Other drugs (O1E)

    Pharmacy dispensing fee for inhalation drug(s); per 30 days (HCPCS:Q0513)

    3 DME suppliers used 20 Medicare Claims 20 Services Paid

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 41030 ZIP code area.

New Patients Visit Costs *

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

  • Average New Patient Price $84.75
  • Minimum New Patient Price $54.72
  • Maximum New Patient Price $168.41
  • Average New Patient Copayment $21.18
  • Minimum New Patient Copayment $13.68
  • Maximum New Patient Copayment $42.1

Established Patients Visit Costs *

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

  • Average Established Patient Price $98.06
  • Minimum Established Patient Price $16.65
  • Maximum Established Patient Price $137.34
  • Average Established Patient Copayment $24.51
  • Minimum Established Patient Copayment $4.16
  • Maximum Established Patient Copayment $34.33

* 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: 95.55 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: 93.91

    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: 95.33

    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.

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 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 2020. The reported codes are based on the top 5 codes for each available specialty, excluding evaluation and management codes.

  • 136

    Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit (HCPCS:G0439)

  • 134

    Administration of influenza virus vaccine (HCPCS:G0008)

  • 117

    Vaccine for influenza for injection into muscle (HCPCS:90662)

  • 115

    Injection beneath the skin or into muscle for therapy, diagnosis, or prevention (HCPCS:96372)

  • 33

    Automated urinalysis test (HCPCS:81003)

  • 23

    Administration of pneumococcal vaccine (HCPCS:G0009)

  • 12

    Photography of the retina (HCPCS:92250)

  • 12

    Routine ekg using at least 12 leads including interpretation and report (HCPCS:93000)

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. Viral Patel is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
ST ELIZABETH EDGEWOOD1 MEDICAL VILLAGE DRIVE
EDGEWOOD, KY 41017
(859) 301-2000Acute Care Hospitals
ST ELIZABETH FLORENCE4900 HOUSTON ROAD
FLORENCE, KY 41042
(859) 212-5220Acute Care Hospitals
ST ELIZABETH GRANT238 BARNES ROAD
WILLIAMSTOWN, KY 41097
(859) 824-8105Critical Access 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.
1003012428
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
200301444
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 = 88

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 12 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1891197273 RYAN FREIBERT D.O.
Individual
Neuromusculoskeletal Medicine & OMM405 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 Practitioner405 VIOLET RD
CRITTENDEN, KY 41030
(859) 428-1610
1891285938HEALTHPOINT FAMILY CARE, INC.
Organization
Clinic/Center (Federally Qualified Health Center (FQHC))405 VIOLET RD
CRITTENDEN, KY 41030
(859) 655-6100
1518989334DR. KATHIE E MORGAN MD
Individual
Family Medicine405 VIOLET RD
CRITTENDEN, KY 41030
(859) 428-1610
1942261250DR. BRADFORD ALAN QUATKEMEYER MD
Individual
Family Medicine405 VIOLET RD
CRITTENDEN, KY 41030
(859) 428-1610
1750899142 WILLIAM TRAVIS YOUNG ARNP, FNP-C
Individual
Nurse Practitioner405 VIOLET RD
CRITTENDEN, KY 41030
(859) 903-0268
1366539652MRS. SUZANNE MICHELLE FERNBACH PA-C
Individual
Physician Assistant405 VIOLET RD
CRITTENDEN, KY 41030
(859) 903-0268
1952415788 OSCAR O PEREZ JR. DO
Individual
Family Medicine405 VIOLET RD
CRITTENDEN, KY 41030
(859) 903-0268
1154087781 RACHEL L STUCK FNP
Individual
Nurse Practitioner405 VIOLET RD
CRITTENDEN, KY 41030
(859) 428-1610
1760817142 JESSICA BOKELMAN DO
Individual
Family Medicine405 VIOLET RD
CRITTENDEN, KY 41030
(859) 903-0268
1871982926 MIRAN H. MCCLENDON LCADC, LPCC
Individual
Counselor (Mental Health)405 VIOLET RD
CRITTENDEN, KY 41030
(859) 301-5901

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1003012428, enumerated in the NPI registry as an "individual" on June 22, 2007

The provider is located at 405 Violet Rd Crittenden, Ky 41030 and the phone number is (859) 428-1610

The provider's speciality is Family Medicine with taxonomy code 207Q00000X

The provider has more than 20 years of experience. He graduated from University Of Pikeville, Kentucky College Of Osteopathic Med in 2004.

The provider might be accepting Accepts: Ambetter from Buckeye Health Plan, Ambetter from. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Yes, as of June 11, 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.

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.

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.

The most common procedures or services performed by this practitioner are: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit, Administration of influenza virus vaccine, Vaccine for influenza for injection into muscle, Injection beneath the skin or into muscle for therapy, diagnosis, or prevention, Automated urinalysis test, Administration of pneumococcal vaccine, Photography of the retina and Routine ekg using at least 12 leads including interpretation and report.

The practitioner is affiliated to the following hospital(s): ST ELIZABETH EDGEWOOD, ST ELIZABETH FLORENCE and ST ELIZABETH GRANT. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

This NPI record 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].
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.