|Provider Name||DR. CARL JAN GILMORE M.D.|
|Location Address||MSC08 4770 1 UNIVERSITY OF NEW MEXICO ALBUQUERQUE, NM 87131|
|Location Phone||(505) 272-6472|
|Mailing Address||7464 SIDEWINDER DR NE ALBUQUERQUE, NM 87113|
|NPI Entity Type||Individual|
|Medical School Name||UNIVERSITY OF NEW MEXICO SCHOOL OF MEDICINE|
|Is Sole Proprietor?||No|
|Last Update Date||07-08-2007|
Carl Gilmore 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.
Carl Gilmore 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. According to claims data he has hospital affiliations with Christus St Vincent Regional Medical Center and Presbyterian Hospital.
The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 99.47, 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: $21.82 for a new patient copayment and $17.7 for an established patient copayment.
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.
|Type||Allopathic & Osteopathic Physicians|
|Taxonomy Description||An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.|
1 UNIVERSITY OF NEW MEXICO
Phone: (505) 272-6472
7464 SIDEWINDER DR NE
Phone: (505) 341-3333
PECOS Enrollment and Medicare Participation Status
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.
|Registered in PECOS?||Yes|
|PECOS PAC ID||8820237191|
|PECOS Enrollment ID||I20130617000590|
|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 or refer Durable Medical Equipment (DMEPOS)||Yes|
|Eligible order r refer Home Health Agency (HHA)||Yes|
|Eligible order r refer Power Mobility Devices||Yes|
Physician Office Visit Costs
The provider accepts as payment the Medicare approved amount, beneficiaries under these health plans should not be billed for more than the approved deductible and coinsurance amounts. The tables below display 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 87131 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|
|Minimum New Patient Copayment||Maximum New Patient Copayment||Typical New Patient Copayment|
|Established Patients Office Visits Costs *|
|Most Utilized Procedure Code for established patients office visits: 99213|
|Minimum Established Patient Pricing||Maximum Established Patient Pricing||Typical Established Patient Pricing|
|Minimum Established Patient Copayment||Maximum Established Patient Copayment||Typical Established Patient Copayment|
* 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.
|MIPS Measure||Score Weight||Score|
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 (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.
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.
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.
|MIPS Final Score||-||99.47|
|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.|
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.
- 52Aspiration and/or injection of large joint or joint capsule (HCPCS:20610)
- 15Repair of knee joint (HCPCS:27447)
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. Carl Gilmore is affiliated with the following medical facilities:
|Hospital Name||Address||Phone||Hospital Type||CMS Certification Number (CCN)||Overall Rating|
|CHRISTUS ST VINCENT REGIONAL MEDICAL CENTER||455 ST MICHAEL'S DRIVE|
SANTA FE, NM 87505
|(505) 913-3361||Acute Care Hospitals||320002|
|PRESBYTERIAN HOSPITAL||1100 CENTRAL AVENUE SE|
ALBUQUERQUE, NM 87106
|(505) 923-5364||Acute Care Hospitals||320021|
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.|
|Step 1: Double the value of the alternate digits, beginning with the rightmost digit.|
|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 + 1 + 8 + 24 = 47|
|Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.|
|50 - 47 = 3||3|
The NPI number 1003012493 is valid because the calculated check digit 3 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 2 providers are registered at the same or nearby location.
Frequently Asked Questions
What is Dr. Carl Gilmore M.D. NPI number?
The NPI number assigned to this healthcare provider is 1003012493, enumerated in the NPI registry as an "individual" on June 22, 2007
Where is the provider located?
The provider is located at Msc08 4770 1 University Of New Mexico Albuquerque, Nm 87131 and the phone number is (505) 272-6472
What is the provider specialty code?
The provider's speciality is Orthopaedic Surgery with taxonomy code 207X00000X
How many years of experience does Dr. Carl Gilmore M.D. have?
The provider has more than 17 years of experience. He graduated from University Of New Mexico School Of Medicine in 2007.
Is Dr. Carl Gilmore M.D. registered in PECOS?
Yes, as of September 14, 2023 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.
What are Dr. Carl Gilmore M.D. Quality Ratings?
The provider has an overall high rating in the following quality measures: quality clinical practices and patient outcomes and experiences.
How much is a visit to Dr. Carl Gilmore M.D.?
Medicare beneficiaries should expect a typical cost of $87.31 with an average copayment of $21.82 for new patient appointments. Established patients should expect a typical charge of $70.8 and an average copayment of 17.7. Please review your insurance plan or contact the provider directly to determine your specific costs.
What are some of the services provided by Dr. Carl Gilmore M.D.?
The most common procedures or services performed by this practitioner are: Aspiration and/or injection of large joint or joint capsule and Repair of knee joint.
Is Dr. Carl Gilmore M.D. affiliated to any hospitals?
How do I update my NPI information?
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].
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