DR. JOSHUA BLAKE WHARTON M.D. NPI 1003014762

Dermatology in Guntersville, AL

Individual Male Years of Experience 17 Dermatology PECOS Enrolled Accepts Medicare Approved Payment MIPS Quality Score 93.3 Medicare Quality Reporting

About DR. JOSHUA BLAKE WHARTON M.D.

Joshua Wharton is a provider established in Guntersville, Alabama and his medical specialization is Dermatology with more than 17 years of experience. He graduated from University Of Alabama School Of Medicine in 2006. The NPI number of Joshua Wharton is 1003014762 and was 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 April 2022.

A dermatologist like Dr. Joshua Blake Wharton M.d. 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.

NPI

1003014762

Provider NameDR. JOSHUA BLAKE WHARTON M.D.
Provider Location Address2307 HOMER CLAYTON DR GUNTERSVILLE, AL 35976
Provider Mailing Address2307 HOMER CLAYTON DR GUNTERSVILLE, AL 35976
GenderMale
NPI Entity TypeIndividual
Medical School NameUNIVERSITY OF ALABAMA SCHOOL OF MEDICINE
Graduation Year2006
Is Sole Proprietor?No
Enumeration Date07-04-2007
Last Update Date04-28-2022



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.

Joshua Wharton 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 Marshall Medical Centers.

The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 93.3, 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 provider also has detailed performance information the following quality measures: biopsy follow-up, clinical data registry reporting, documentation of current medications in the medical record, e-prescribing, melanoma: continuity of care - recall system, preventive care and screening: body mass index (bmi) screening and follow-up plan, preventive care and screening: tobacco use: screening and cessation intervention, preventive care and screening: unhealthy alcohol use: screening & brief counseling, provide 24/7 access to mips eligible clinicians or groups who have real-time access to patient's medical record, provide patients electronic access to their health information and security risk analysis.

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.



Primary Taxonomy

Taxonomy Code207N00000X
ClassificationDermatology
TypeAllopathic & Osteopathic Physicians
License No.002457
License StateGA
Taxonomy DescriptionA 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.

Business Address

DR. JOSHUA BLAKE WHARTON M.D.
2307 HOMER CLAYTON DR
GUNTERSVILLE, AL
ZIP 35976
Phone: (256) 571-8770
Fax: (256) 571-8775

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Mailing Address

DR. JOSHUA BLAKE WHARTON M.D.
2307 HOMER CLAYTON DR
GUNTERSVILLE, AL
ZIP 35976
Phone: (256) 571-8770


PECOS Enrollment and Medicare Participation

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 ID9436273430
PECOS Enrollment IDI20100827000331
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 ImagingYes
Eligible order / refer Durable Medical EquipmentYes
Eligible order / refer Home Health Agency (HHA)Yes
Eligible order / refer Power Mobility DevicesYes

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 35976 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
$55.54 $170.61 $85.95
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$13.88 $42.65 $21.48
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
$16.93 $139.08 $69.84
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$4.23 $34.77 $17.46

* 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% 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 (PI) 25% 67
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 15% 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 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 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.
MIPS Final Score - 93.3
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.

MIPS Quality Measures

The following performance measures were reported under the Merit-Based Incentive Payment System (MIPS) and Qualified Clinical Data Registry (QCDR) quality measures program.

Quality Measure Performance Number of Patients
Biopsy Follow-Up 81% 131
Percentage of new patients whose biopsy results have been reviewed and communicated to the primary care/referring physician and patient
Clinical Data Registry ReportingYesN/A
The MIPS eligible clinician is in active engagement to submit data to a clinical data registry.
Documentation of Current Medications in the Medical Record 100% 17126
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% 663
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using CEHRT.
Melanoma: Continuity of Care - Recall System 100% 206
Percentage of patients, regardless of age, with a current diagnosis of melanoma or a history of melanoma whose information was entered, at least once within a 12 month period, into a recall system that includes:- A target date for the next complete physical skin exam, AND- A process to follow up with patients who either did not make an appointment within the specified timeframe or who missed a scheduled appointment
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 99% 2049
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 encounterNormal Parameters: Age 18 years and older BMI => 18.5 and < 25 kg/m2
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 100% 90
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
Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling 100% 228
Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 24 months AND who received brief counseling if identified as an unhealthy alcohol 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/orProvision 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 Patients Electronic Access to Their Health Information 61% 1314
For at least one unique patient seen by the MIPS eligible clinician: (1) The patient (or the patient-authorized representative) is provided timely access to view online, download, and transmit his or her health information; and (2) The MIPS eligible clinician ensures the patient's health information is available for the patient (or patient-authorized representative) to access using any application of their choice that is configured to meet the technical specifications of the Application Programing Interface (API) in the MIPS eligible clinician's certified electronic health record technology (CEHRT).
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 electronic health record technology (CEHRT) in accordance with requirements in 45 CFR 164.312(a)(2)(iv) and 164.306(d)(3), implement security updates as necessary, and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.

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.

  • 8106Destruction of 2-14 skin growths (HCPCS:17003)
  • 2470Destruction of skin growth (HCPCS:17000)
  • 1448Destruction of up to 14 skin growths (HCPCS:17110)
  • 1085Biopsy of single growth of skin and/or tissue (HCPCS:11100)
  • 288Biopsy of each additional growth of skin and/or tissue (HCPCS:11101)
  • 178Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (HCPCS:13132)
  • 34Injection, triamcinolone acetonide, not otherwise specified, 10 mg (HCPCS:J3301)

Hospital Affiliations

Medicare hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the Medicare 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 CMS Certification Number (CCN) Overall Rating
MARSHALL MEDICAL CENTERS2505 U S HIGHWAY 431 NORTH
BOAZ, AL 35957
(256) 593-8310Acute Care Hospitals10005

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
1750728580MRS. AMELIA MCCARRELL FRAZIER CRNP
Individual
Nurse Practitioner (Adult Health)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

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
Dr. Joshua Blake Wharton M.d. is registered as an entity type code: 1. The entity type code describes the type of health care provider that is being assigned an NPI. The entity type codes are:

  • 1 = Person: individual human being who furnishes health care.
  • 2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
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.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.