DR. JOSHUA BLAKE WHARTON M.D.
NPI 1003014762
Dermatology in Guntersville, AL


Quality Rating: 100 out of 100 score

NPI Status: Active since July 04, 2007

Contact Information

2307 HOMER CLAYTON DR
GUNTERSVILLE, AL
ZIP 35976
Phone: (256) 571-8770
Fax: (256) 571-8775

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  • Individual
  • Male
  • Years of Experience 18
  • Dermatology
  • PECOS Enrolled
  • Accepts Medicare Approved Payment
  • Medicare Quality Reporting

About JOSHUA WHARTON

Joshua Wharton is a provider established in Guntersville, Alabama and his medical specialization is Dermatology with more than 18 years of experience. He graduated from University Of Alabama School Of Medicine in 2006. The healthcare provider is registered in the NPI registry with number 1003014762 assigned on July 2007. The practitioner's primary taxonomy code is 207N00000X with license number 002457 (GA). The provider is registered as an individual and his NPI record was last updated 2 years ago.

NPI
1003014762
Provider Name
DR. JOSHUA BLAKE WHARTON M.D.
Gender
Male
Entity Type
Individual
Location Address
2307 HOMER CLAYTON DR GUNTERSVILLE, AL 35976
Location Phone
(256) 571-8770
Location Fax
(256) 571-8775
Mailing Address
2307 HOMER CLAYTON DR GUNTERSVILLE, AL 35976
Mailing Phone
(256) 571-8770
Medical School Name
UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE
Graduation Year
2006
Is Sole Proprietor?
No
Enumeration Date
07-04-2007
Last Update Date
04-28-2022
Code Navigator

A dermatologist like Joshua Wharton is a medical specialty involving the management of skin conditions and diseases. Dermatologists diagnose some sexually transmitted diseases, warts, cancer, acne, dermatitis and may offer cosmetic treatments, and therapies that reduce age spots and wrinkles.

Joshua Wharton 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 100, 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: biopsy follow-up, documentation of current medications in the medical record, e-prescribing, medication reconciliation, patient-specific education, preventive care and screening: tobacco use: screening and cessation intervention, provide 24/7 access to mips eligible clinicians or groups who have real-time access to patient's medical record, provide patient access, secure messaging, security risk analysis and specialized registry reporting.

The typical physician office visit costs for Medicare beneficiaries in this area are: $21.48 for a new patient copayment and $17.46 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

Dermatology

Taxonomy Code
207N00000X
Type
Allopathic & Osteopathic Physicians
License No.
002457
License State
GA
Taxonomy Description
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Insurance Plans Accepted

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

  • 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
    • Clear Silver with Walgreens - HMO
    • Clear Silver with Walgreens + Vision + Adult Dental - HMO
    • Complete Gold with Walgreens - HMO
    • Complete Gold with Walgreens + Vision + Adult Dental - HMO
    • Complete Silver with Walgreens - 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
    • Clear Gold + Vision + Adult Dental - HMO
    • Clear Silver - HMO
    • Clear Silver + Vision + Adult Dental - HMO
    • Complete Gold - HMO
    • Complete Gold + Vision + Adult Dental - HMO
  • Ambetter from Sunshine 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 - 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
    • Elite Bronze - EPO
  • 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
    • Elite Bronze + Vision + Adult Dental - EPO
    • Everyday Bronze - EPO
    • Everyday Bronze + Vision + Adult Dental - EPO
    • Everyday Silver - EPO
    • Everyday Silver + Vision + Adult Dental - EPO
  • 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
  • Blue Cross and Blue Shield of Alabama

    • Blue HSA Bronze - PPO
    • Blue Protect - PPO
    • Blue Saver Bronze - PPO
    • Blue Value Gold - PPO
    • Blue Value Silver - PPO
    • Blue Access Gold for Business - PPO
    • Blue Choice Platinum for Business - PPO
    • Blue HSA Silver for Business - PPO
    • Blue Saver Bronze for Business - PPO
    • Blue Saver Gold for Business - PPO
  • UnitedHealthcare

    • UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals) - EPO
    • UHC Bronze Essential ($0 Virtual Urgent Care, $0 Insulin, No Referrals) - EPO
    • UHC Bronze Standard (No Referrals) - EPO
    • UHC Bronze Value ($0 Virtual Urgent Care + $0 PCP Visits, $5 Tier 2 Rx, $0 Insulin, No Referrals) - EPO
    • UHC Bronze Value HSA (No Referrals) - EPO
    • UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) - EPO
    • UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, $0 Insulin, No Referrals) - EPO
    • UHC Gold Standard (No Referrals) - EPO
    • UHC Gold Value ($0 Virtual Urgent Care + $0 PCP Visits, $1 Tier 2 Rx, $0 Insulin, No Referrals) - EPO
    • UHC Silver Advantage ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) - EPO

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

PECOS Enrollment and Medicare Participation Status

Joshua Wharton 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: 9436273430

    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: I20100827000331

    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

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 35976 ZIP code area.

New Patients Visit Costs *

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

  • Average New Patient Price $85.95
  • Minimum New Patient Price $55.54
  • Maximum New Patient Price $170.61
  • Average New Patient Copayment $21.48
  • Minimum New Patient Copayment $13.88
  • Maximum New Patient Copayment $42.65

Established Patients Visit Costs *

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

  • Average Established Patient Price $69.84
  • Minimum Established Patient Price $16.93
  • Maximum Established Patient Price $139.08
  • Average Established Patient Copayment $17.46
  • Minimum Established Patient Copayment $4.23
  • Maximum Established Patient Copayment $34.77

* 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: 100 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: 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.

  • 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.

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
Biopsy Follow-Up 81% 137
Percentage of new patients whose biopsy results have been reviewed and communicated to the primary care/referring physician and patient by the performing physician
Documentation of Current Medications in the Medical Record 100% 3662
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration
e-Prescribing 91% 706
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Medication Reconciliation 74% 140
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
Patient-Specific Education 100% 1273
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 3% 178
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Provide 24/7 Access to MIPS Eligible Clinicians or Groups Who Have Real-Time Access to Patient's Medical RecordYesN/A
• Provide 24/7 access to MIPS eligible clinicians, groups, or care teams for advice about urgent and emergent care (e.g., MIPS eligible clinician and care team access to medical record, cross-coverage with access to medical record, or protocol-driven nurse line with access to medical record) that could include one or more of the following: • Expanded hours in evenings and weekends with access to the patient medical record (e.g., coordinate with small practices to provide alternate hour office visits and urgent care); • Use of alternatives to increase access to care team by MIPS eligible clinicians and groups, such as e-visits, phone visits, group visits, home visits and alternate locations (e.g., senior centers and assisted living centers); and/or Provision of same-day or next-day access to a consistent MIPS eligible clinician, group or care team when needed for urgent care or transition management.
Provide Patient Access 98% 1273
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information.
Secure Messaging 13% 1273
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period.
Security Risk AnalysisYesN/A
Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.
Specialized Registry ReportingYesN/A
The MIPS eligible clinician is in active engagement to submit data to specialized registry. To earn a 5 % bonus in the promoting interoperability performance category score for submitting to one or more public health or clinical data registries also attest to PI_TRANS_PHCDRR_3_MULTI.

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.

  • 3443

    Destruction of 2-14 skin growths (HCPCS:17003)

  • 993

    Destruction of skin growth (HCPCS:17000)

  • 366

    Destruction of up to 14 skin growths (HCPCS:17110)

  • 366

    Tangential biopsy of single skin lesion (HCPCS:11102)

  • 258

    Removal and microscopic examination of growth of the head, neck, hands, feet, or genitals (first stage, up to 5 tissue blocks) (HCPCS:17311)

  • 187

    Removal and microscopic examination of growth of the head, neck, hands, feet, or genitals (HCPCS:17312)

  • 135

    Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs (HCPCS:13121)

  • 104

    Tangential biopsy of additional skin lesion (HCPCS:11103)

  • 69

    Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (HCPCS:13132)

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. Joshua Wharton is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
MARSHALL MEDICAL CENTERS2505 U S HIGHWAY 431 NORTH
BOAZ, AL 35957
(256) 593-8310Acute 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.
1003014762
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2003018712
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 0 + 0 + 3 + 0 + 1 + 8 + 7 + 1 + 2 + 24 = 48
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
50 - 48 = 22

The NPI number 1003014762 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 7 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1689993156DERMATOLOGY OF NORTH ALABAMA, INC.
Organization
Dermatology2307 HOMER CLAYTON DR
GUNTERSVILLE, AL 35976
(205) 422-1593
1306802251MS. CHRISTA B HEARD CRNP
Individual
Nurse Practitioner (Adult Health)2307 HOMER CLAYTON DR
GUNTERSVILLE, AL 35976
(256) 571-8770
1649695065 BRIGETT PAYNE APRN, FNP-C
Individual
Nurse Practitioner (Family)2307 HOMER CLAYTON DR
GUNTERSVILLE, AL 35976
(256) 571-8770
1578683090MARSHALL MEDICAL CENTER NORTH
Organization
Home Health2307 HOMER CLAYTON DR
GUNTERSVILLE, AL 35976
(256) 571-8003
1669061461MS. TAYLOR DANIELLE PRINCE CRNP
Individual
Nurse Practitioner (Family)2307 HOMER CLAYTON DR
GUNTERSVILLE, AL 35976
(256) 571-8770
1831859412 HANNAH HOVEY BROCATO
Individual
Nurse Practitioner (Family)2307 HOMER CLAYTON DR
GUNTERSVILLE, AL 35976
(256) 571-8770
1750728580MRS. AMELIA MCCARRELL FRAZIER CRNP
Individual
Nurse Practitioner (Adult Health)2307 HOMER CLAYTON DR
GUNTERSVILLE, AL 35976
(256) 571-8770

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1003014762, enumerated in the NPI registry as an "individual" on July 04, 2007

The provider is located at 2307 Homer Clayton Dr Guntersville, Al 35976 and the phone number is (256) 571-8770

The provider's speciality is Dermatology with taxonomy code 207N00000X

The provider has more than 18 years of experience. He graduated from University Of Alabama School Of Medicine in 2006.

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

Yes, as of May 21, 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 $85.95 with an average copayment of $21.48 for new patient appointments. Established patients should expect a typical charge of $69.84 and an average copayment of 17.46. 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: Destruction of 2-14 skin growths, Destruction of skin growth, Destruction of up to 14 skin growths, Tangential biopsy of single skin lesion, Removal and microscopic examination of growth of the head, neck, hands, feet, or genitals (first stage, up to 5 tissue blocks), Removal and microscopic examination of growth of the head, neck, hands, feet, or genitals, Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs, Tangential biopsy of additional skin lesion and Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet.

The practitioner is affiliated to the following hospital(s): MARSHALL MEDICAL CENTERS. 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 04, 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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