DR. RICHARD C SPINALE DO NPI 1003013657
Surgery in Garden City, MI
About DR. RICHARD C SPINALE DO
Richard Spinale is a provider established in Garden City, Michigan and his medical specialization is Surgery with more than 40 years of experience. The NPI number of this provider is 1003013657 and was assigned on June 2007. The practitioner's primary taxonomy code is 208600000X with license number 009110 (MI). The provider is registered as an individual and his NPI record was last updated 16 years ago.
| NPI | 1003013657 |
| Provider Name | DR. RICHARD C SPINALE DO |
| Location Address | 6255 INKSTER RD SUITE 207 GARDEN CITY, MI 48135 |
| Location Phone | (734) 427-6570 |
| Mailing Address | 6255 INKSTER RD SUITE 207 GARDEN CITY, MI 48135 |
| Gender | Male |
| NPI Entity Type | Individual |
| Medical School Name | OTHER |
| Graduation Year | 1983 |
| Is Sole Proprietor? | Yes |
| Enumeration Date | 06-28-2007 |
| Last Update Date | 07-08-2007 |
A surgeon like Richard Spinale treats injuries, diseases, and deformities through surgical operations. A surgeon could correct physical deformities, repair bone and tissue, or perform preventive or elective surgeries. Surgeons also examine patients, perform and interpret diagnostic tests, and provide counsel on preventive healthcare.Richard Spinale 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.
Richard Spinale 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 typical physician office visit costs for Medicare beneficiaries in this area are: $23.37 for a new patient copayment and $18.9 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 | 208600000X |
| Classification | Surgery |
| Type | Allopathic & Osteopathic Physicians |
| License No. | 009110 |
| License State | MI |
| Taxonomy Description | A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
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
6255 INKSTER RD
SUITE 207
GARDEN CITY, MI
ZIP 48135
Phone: (734) 427-6570
Fax: (734) 427-6140
Mailing Address
6255 INKSTER RD
SUITE 207
GARDEN CITY, MI
ZIP 48135
Phone: (734) 427-6570
Fax: (734) 427-6140
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 | 1759462807 |
| PECOS Enrollment ID | I20080115000718 |
| 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 48135 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 |
| $60.64 | $184.65 | $93.48 |
| Minimum New Patient Copayment | Maximum New Patient Copayment | Typical New Patient Copayment |
| $15.16 | $46.16 | $23.37 |
| 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 |
| $18.56 | $150 | $75.6 |
| Minimum Established Patient Copayment | Maximum Established Patient Copayment | Typical Established Patient Copayment |
| $4.64 | $37.5 | $18.9 |
* 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. | |||
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.
- 47Diagnostic examination of large bowel using an endoscope (HCPCS:45378)
- 40Removal of polyps or growths of large bowel using an endoscope (HCPCS:45385)
- 19Removal of gallbladder using an endoscope (HCPCS:47562)
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 |
|---|---|---|
| E38094 | MEDICARE UPIN (02) | MI |
| 2842362 | MEDICAID (05) | MI |
| 5820254 | MEDICARE ID-TYPE UNSPECIFIED (04) | MI |
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 | 3 | 6 | 5 | 7 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 0 | 0 | 3 | 0 | 1 | 6 | 6 | 10 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 0 + 0 + 3 + 0 + 1 + 6 + 6 + 1 + 0 + 24 = 43 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 50 - 43 = 7 | 7 | ||||||||
The NPI number 1003013657 is valid because the calculated check digit 7 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 |
|---|---|---|---|
| 1497755177 | DR. STEPHEN B GOLDFARB D.O. Individual | Internal Medicine (Hematology & Oncology) | 6255 INKSTER RD SUITE 105 GARDEN CITY, MI 48135 (734) 522-0404 |
| 1902889884 | RICHARD C SPINALE DO PC Organization | Surgery | 6255 INKSTER RD SUITE 207 GARDEN CITY, MI 48135 (734) 427-6570 |
| 1215902382 | RONALD LUTSIC D.O. Individual | Radiology (Radiation Oncology) | 6255 INKSTER RD GARDEN CITY, MI 48135 (734) 522-8540 |
| 1952361677 | DR. LEONARD T GLINSKI DO Individual | Otolaryngology (Otolaryngology/Facial Plastic Surgery) | 6255 INKSTER RD SUITE 202 GARDEN CITY, MI 48135 (734) 261-8040 |
| 1932143013 | DR. WILLIAM DAVIDSON D.O. Individual | Urology | 6255 INKSTER RD GARDEN CITY, MI 48135 (734) 425-7230 |
| 1922219260 | CYNTHIA MORIN P.A. Individual | Physician Assistant | 6255 INKSTER RD GARDEN CITY, MI 48135 (734) 522-8540 |
| 1992992671 | JOHN H MORRISON JR DO PC Organization | Internal Medicine (Pulmonary Disease) | 6255 INKSTER RD STE 204 GARDEN CITY, MI 48135 (734) 525-0350 |
| 1740469451 | LEONARD T GLINSKI DO PC Organization | Otolaryngology (Otolaryngology/Facial Plastic Surgery) | 6255 INKSTER RD SUITE 202 GARDEN CITY, MI 48135 (734) 261-8040 |
| 1043491343 | MICHAEL S. SHERMAN, DO, PC Organization | Ophthalmology | 6255 INKSTER RD SUITE 303 GARDEN CITY, MI 48135 (734) 421-0790 |
| 1780856393 | REUBEN D ELIUK, DO, PLC Organization | Internal Medicine | 6255 INKSTER RD SUITE 101 GARDEN CITY, MI 48135 (734) 421-4850 |
| 1336312867 | PREETI S KELKAR M.D. Individual | Radiology (Radiation Oncology) | 6255 INKSTER RD STE B-7 GARDEN CITY, MI 48135 (734) 522-8540 |
| 1275706640 | STEPHEN B GOLDFARB DO PC Organization | Internal Medicine (Hematology & Oncology) | 6255 INKSTER RD STE 105 GARDEN CITY, MI 48135 (734) 522-0404 |
| 1245403492 | LOUIS JACOBS, D.O., P.C. Organization | Neurological Surgery | 6255 INKSTER RD SUITE 206 GARDEN CITY, MI 48135 (734) 421-0044 |
| 1770815615 | ANKLE AND FOOTCARE SPECIALISTS PLC Organization | Podiatrist | 6255 INKSTER RD SUITE 307 GARDEN CITY, MI 48135 (734) 751-2533 |
| 1427143387 | ROBERT GROSS DO Individual | Surgery | 6255 INKSTER RD SUITE 204 GARDEN CITY, MI 48135 (734) 458-4492 |
| 1740375518 | GREAT LAKES ORTHOPAEDICS Organization | Orthopaedic Surgery | 6255 INKSTER RD STE 103 GARDEN CITY, MI 48135 (734) 422-8400 |
| 1396716544 | JOSEPH L WALKIEWICZ D.O. Individual | Orthopaedic Surgery | 6255 INKSTER RD SUITE 103 GARDEN CITY, MI 48135 (734) 422-8400 |
| 1023423050 | METRO RHEUMATOLOGY, PLLC Organization | Internal Medicine (Rheumatology) | 6255 INKSTER RD SUITE 306 GARDEN CITY, MI 48135 (313) 595-4864 |
| 1477538056 | PRIME HEALTHCARE SERVICES - GARDEN CITY, LLC Organization | Pharmacy (Community/Retail Pharmacy) | 6255 INKSTER RD STE 106 GARDEN CITY, MI 48135 (734) 458-4224 |
| 1174522163 | DR. LOUIS ISRAEL JACOBS D.O. Individual | Neurological Surgery | 6255 INKSTER RD SUITE #206 GARDEN CITY, MI 48135 (734) 421-0044 |
Frequently Asked Questions
What is Dr. Richard Spinale DO NPI number?
The NPI number assigned to this healthcare provider is 1003013657, registered as an "individual" on June 28, 2007
Where is Dr. Richard Spinale DO located?
The provider is located at 6255 Inkster Rd Suite 207 Garden City, Mi 48135 and the phone number is (734) 427-6570
Which is Dr. Richard Spinale DO specialty?
The provider's speciality is Surgery
How many years of experience does Dr. Richard Spinale DO have?
The provider has more than 40 years of experience.
What insurance does Dr. Richard Spinale DO 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. Richard Spinale DO 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.
How much is a visit to Dr. Richard Spinale DO?
Medicare beneficiaries should expect a typical cost of $93.48 with an average copayment of $23.37 for new patient appointments. Established patients should expect a typical charge of $75.6 and an average copayment of 18.9. Please review your insurance plan or contact the provider directly to determine your specific costs.
What are some of the services provided by Dr. Richard Spinale DO?
The most common procedures or services performed by this practitioner are: Diagnostic examination of large bowel using an endoscope, Removal of polyps or growths of large bowel using an endoscope and Removal of gallbladder using an endoscope.
How do I update my NPI information?
The NPI record of Dr. Richard Spinale DO was last updated on June 28, 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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