DR. ROBERT JOEL OTTO M.D.
NPI 1003013947
Orthopaedic Surgery in Nashville, TN


Quality Rating: 85.74 out of 100 score

NPI Status: Active since July 02, 2007

Contact Information

2400 PATTERSON ST STE 100
NASHVILLE, TN
ZIP 37203
Phone: (615) 342-0038

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  • Individual
  • Male
  • Years of Experience 17
  • Orthopaedic Surgery
  • PECOS Enrolled
  • Accepts Medicare Approved Payment

About ROBERT OTTO

Robert Otto is a provider established in Nashville, Tennessee and his medical specialization is Orthopaedic Surgery with more than 17 years of experience. He graduated from University Of Missouri, Kansas City, School Of Medicine in 2007. The healthcare provider is registered in the NPI registry with number 1003013947 assigned on July 2007. The practitioner's primary taxonomy code is 207X00000X with license number 2014006166 (MO). The provider is registered as an individual and his NPI record was last updated 2 years ago.

NPI
1003013947
Provider Name
DR. ROBERT JOEL OTTO M.D.
Gender
Male
Entity Type
Individual
Location Address
2400 PATTERSON ST STE 100 NASHVILLE, TN 37203
Location Phone
(615) 342-0038
Mailing Address
2400 PATTERSON ST SUITE 100 NASHVILLE, TN 37203
Mailing Phone
(615) 342-0038
Medical School Name
UNIVERSITY OF MISSOURI, KANSAS CITY, SCHOOL OF MEDICINE
Graduation Year
2007
Is Sole Proprietor?
No
Enumeration Date
07-02-2007
Last Update Date
01-12-2022
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Robert Otto 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 85.74, 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: $21.08 for a new patient copayment and $17.19 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

Orthopaedic Surgery

Taxonomy Code
207X00000X
Type
Allopathic & Osteopathic Physicians
License No.
2014006166
License State
MO
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.

Insurance Plans Accepted

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

  • Ambetter from Arizona Complete Health

    • Standard Expanded Bronze SELECT - HMO
    • Standard Gold SELECT - HMO
    • Standard Silver SELECT - HMO
  • Ambetter from Arkansas Health & Wellness

    • Choice Bronze HSA (QualChoice) - POS
    • Complete Gold - PPO
    • Complete Gold + Vision + Adult Dental - PPO
    • Complete Silver - PPO
    • Complete Silver + Vision + Adult Dental - PPO
  • 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
  • Ambetter from Magnolia Health

    • Ambetter Virtual Access Bronze (Virtual PCP selection required) - HMO
    • Ambetter Virtual Access Gold (Virtual PCP selection required) - HMO
    • Ambetter Virtual Access Silver (Virtual PCP selection required) - HMO
    • Choice Bronze HSA with Walgreens - HMO
    • Choice Bronze HSA with Walgreens + Vision + Adult Dental - HMO
  • Ambetter from Peach State Health Plan

    • Choice Bronze HSA - HMO
    • Choice Bronze HSA + Vision + Adult Dental - HMO
    • Clear Bronze - HMO
    • Clear Bronze + Vision + Adult Dental - HMO
    • Clear Gold - HMO
  • Ambetter from Sunshine Health

    • Complete SELECT Gold with Select Providers - HMO
    • Elite SELECT Bronze with Select Providers - HMO
    • Focused SELECT Silver with Select Providers - HMO
    • Standard Expanded Bronze SELECT - HMO
    • Standard Gold SELECT - HMO
  • Ambetter of Alabama

    • Choice Bronze HSA - EPO
    • Choice Bronze HSA + Vision + Adult Dental - EPO
    • Clear Silver - EPO
    • Clear Silver + Vision + Adult Dental - EPO
    • Elite Bronze - EPO
  • Ambetter of North Carolina

    • Ambetter Virtual Access Bronze (Virtual PCP selection required) - HMO
    • Ambetter Virtual Access Gold (Virtual PCP selection required) - HMO
    • Ambetter Virtual Access Silver (Virtual PCP selection required) - HMO
    • Choice Bronze HSA - HMO
    • Choice Bronze HSA + 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
  • BlueCross BlueShield of Tennessee

    • BlueCross B07S HSA + $0 Virtual Care for Medical & Mental Health - EPO
    • BlueCross B08S $0 Virtual Care for Medical & Mental Health - EPO
    • BlueCross B10S $0 Virtual Care for Medical & Mental Health - EPO
    • BlueCross B15S $0 Virtual Care for Medical & Mental Health - EPO
    • BlueCross B16S $50 PCP Copay + $0 Virtual Care for Medical & Mental Health - EPO
  • Oscar Insurance Company

    • Bronze Classic 4700 - EPO
    • Bronze Classic PCP Saver Plus - EPO
    • Bronze Classic Standard - EPO
    • Bronze Elite + PCP Saver Plus - EPO
    • Bronze Simple 2 - EPO
  • UnitedHealthcare

    • UHC Bronze Copay Focus (Virtual Urgent Care, No Referrals) - EPO
    • UHC Bronze Essential (Virtual Urgent Care, No Referrals) - EPO
    • UHC Bronze Standard (No Referrals) - EPO
    • UHC Bronze Value (Virtual Urgent Care + PCP Visits, No Referrals) - EPO
    • UHC Bronze Value HSA (No Referrals) - EPO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

PECOS Enrollment and Medicare Participation Status

Robert Otto 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: 6507007390

    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: I20130719000570

    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)

    Walker, heavy duty, wheeled, rigid or folding, any type (HCPCS:E0149)

    3 DME suppliers used 35 Medicare Claims 35 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 37203 ZIP code area.

New Patients Visit Costs *

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

  • Average New Patient Price $84.32
  • Minimum New Patient Price $54.58
  • Maximum New Patient Price $167.19
  • Average New Patient Copayment $21.08
  • Minimum New Patient Copayment $13.64
  • Maximum New Patient Copayment $41.79

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

  • Average Established Patient Price $68.78
  • Minimum Established Patient Price $16.86
  • Maximum Established Patient Price $136.82
  • Average Established Patient Copayment $17.19
  • Minimum Established Patient Copayment $4.21
  • Maximum Established Patient Copayment $34.2

* 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: 85.74 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: 83.23

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

  • 105

    X-ray of hip with pelvis, 2-3 views (HCPCS:73502)

  • 83

    X-ray of knee, 3 views (HCPCS:73562)

  • 64

    X-ray of knee, 4 or more views (HCPCS:73564)

  • 36

    Aspiration and/or injection of large joint or joint capsule (HCPCS:20610)

  • 27

    Repair of knee joint (HCPCS:27447)

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. Robert Otto is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
TRISTAR CENTENNIAL MEDICAL CENTER2300 PATTERSON STREET
NASHVILLE, TN 37203
(615) 342-1000Acute Care Hospitals
TRISTAR STONECREST MEDICAL CENTER200 STONECREST BOULEVARD
SMYRNA, TN 37167
(615) 768-2000Acute Care 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.
1003013947
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
200301698
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 + 9 + 8 + 24 = 53
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 53 = 77

The NPI number 1003013947 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 18 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1750731998 WILLIAM ALLEN MARSHALL M.D.
Individual
Orthopaedic Surgery2400 PATTERSON ST STE 100
NASHVILLE, TN 37203
(615) 342-0038
1952980005 ELLIOTT JOSEPH HAYNES APRN, FNP-C
Individual
Nurse Practitioner2400 PATTERSON ST STE 100
NASHVILLE, TN 37203
(615) 342-0038
1124511316 ANGELA MARIA HARRIGER APRN FNP-C
Individual
Nurse Practitioner (Family)2400 PATTERSON ST STE 100
NASHVILLE, TN 37203
(615) 493-1450
1740676394MR. MATTHEW C. CHRISTIE MD
Individual
Orthopaedic Surgery (Adult Reconstructive Orthopaedic Surgery)2400 PATTERSON ST STE 100
NASHVILLE, TN 37203
(615) 342-0038
1790184422 LESLIE NELSON DPT
Individual
Physical Therapist2400 PATTERSON ST STE 100
NASHVILLE, TN 37203
(615) 342-0038
1427462589 LAURA PAYNE
Individual
Physical Therapist2400 PATTERSON ST STE 100
NASHVILLE, TN 37203
(615) 342-0038
1598436248MRS. JACQUELINE CLARE NP-C
Individual
Nurse Practitioner2400 PATTERSON ST STE 100
NASHVILLE, TN 37203
(615) 342-0038
1609436039 KARA MAYNORD
Individual
Physical Therapist2400 PATTERSON ST STE 100
NASHVILLE, TN 37203
(615) 342-0265
1023641990 JOHN TYLER HEARN FNP-BC
Individual
Nurse Practitioner2400 PATTERSON ST STE 100
NASHVILLE, TN 37203
(615) 342-1170
1063773216DR. IRSHAD A SHAKIR M.D.
Individual
Orthopaedic Surgery2400 PATTERSON ST STE 100
NASHVILLE, TN 37203
(615) 342-0038
1205282050 MITCHELL DODSON PT, DPT
Individual
Physical Therapist2400 PATTERSON ST STE 100
NASHVILLE, TN 37203
(615) 342-0038
1891005856 JOHN D PAINTER FNP
Individual
Nurse Practitioner2400 PATTERSON ST STE 100
NASHVILLE, TN 37203
(615) 324-1723
1033452784MRS. LEAH MICHELLE CARNEY
Individual
Physical Therapist2400 PATTERSON ST STE 100
NASHVILLE, TN 37203
(615) 342-0038
1013412832 ALEXANDER DAVID SAVAGE
Individual
Orthopaedic Surgery2400 PATTERSON ST STE 100
NASHVILLE, TN 37203
(615) 342-0038
1265964670 JOSEPH NILAND
Individual
Orthopaedic Surgery2400 PATTERSON ST STE 100
NASHVILLE, TN 37203
(615) 342-0038
1912027491DR. MATTHEW PARKER WILLIS MD
Individual
Orthopaedic Surgery2400 PATTERSON ST STE 100
NASHVILLE, TN 37203
(615) 342-0038
1548993678MRS. HANNAH MARIE BRUCE NP
Individual
Nurse Practitioner (Family)2400 PATTERSON ST STE 100
NASHVILLE, TN 37203
(615) 342-0038
1376305896 ALLISON DENEGRI
Individual
Physician Assistant (Medical)2400 PATTERSON ST STE 100
NASHVILLE, TN 37203
(615) 342-0038

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1003013947, enumerated in the NPI registry as an "individual" on July 02, 2007

The provider is located at 2400 Patterson St Ste 100 Nashville, Tn 37203 and the phone number is (615) 342-0038

The provider's speciality is Orthopaedic Surgery with taxonomy code 207X00000X

The provider has more than 17 years of experience. He graduated from University Of Missouri, Kansas City, School Of Medicine in 2007.

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

Yes, as of May 17, 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.

Medicare beneficiaries should expect a typical cost of $84.32 with an average copayment of $21.08 for new patient appointments. Established patients should expect a typical charge of $68.78 and an average copayment of 17.19. 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: X-ray of hip with pelvis, 2-3 views, X-ray of knee, 3 views, X-ray of knee, 4 or more views, Aspiration and/or injection of large joint or joint capsule and Repair of knee joint.

The practitioner is affiliated to the following hospital(s): TRISTAR CENTENNIAL MEDICAL CENTER and TRISTAR STONECREST MEDICAL CENTER. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

This NPI record was last updated on July 02, 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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