DR. BENJAMIN P NICHOLSON M.D., M.A. NPI 1003016916
Ophthalmology - Retina Specialist in Saint Joseph, MI
About DR. BENJAMIN P NICHOLSON M.D., M.A.
Benjamin Nicholson is a provider established in Saint Joseph, Michigan and his medical specialization is Ophthalmology with a focus in retina specialist with more than 16 years of experience. He graduated from Saint Louis University School Of Medicine in 2007. The NPI number of this provider is 1003016916 and was assigned on July 2007. The practitioner's primary taxonomy code is 207WX0107X with license number 4301106941 (MI). The provider is registered as an individual and his NPI record was last updated 6 years ago.
| NPI | 1003016916 |
| Provider Name | DR. BENJAMIN P NICHOLSON M.D., M.A. |
| Location Address | 2848 NILES RD SAINT JOSEPH, MI 49085 |
| Location Phone | (269) 428-3300 |
| Mailing Address | 2848 NILES RD SAINT JOSEPH, MI 49085 |
| Gender | Male |
| NPI Entity Type | Individual |
| Medical School Name | SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 2007 |
| Is Sole Proprietor? | No |
| Enumeration Date | 07-19-2007 |
| Last Update Date | 03-27-2017 |
Benjamin Nicholson 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.
Benjamin Nicholson 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 65.7, 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: advance care plan and provide education opportunities for new clinicians.
The typical physician office visit costs for Medicare beneficiaries in this area are: $32.68 for a new patient copayment and $17.7 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 | 207WX0107X |
| Classification | Ophthalmology |
| Type | Allopathic & Osteopathic Physicians |
| Specialization | Retina Specialist |
| License No. | 4301106941 |
| License State | MI |
| Taxonomy Description | An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. |
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
2848 NILES RD
SAINT JOSEPH, MI
ZIP 49085
Phone: (269) 428-3300
Fax: (269) 428-5005
Mailing Address
2848 NILES RD
SAINT JOSEPH, MI
ZIP 49085
Phone: (269) 428-3300
Fax: (269) 428-5005
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 | 1759523723 |
| PECOS Enrollment ID | I20150603001565, I20171110001928 |
| 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 49085 ZIP code area.
| New Patients Office Visits Costs * | ||
|---|---|---|
| Most Utilized Procedure Code for new patients office visits: 99204 | ||
| Minimum New Patient Pricing | Maximum New Patient Pricing | Typical New Patient Pricing |
| $56.39 | $172.8 | $130.74 |
| Minimum New Patient Copayment | Maximum New Patient Copayment | Typical New Patient Copayment |
| $14.09 | $43.2 | $32.68 |
| 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 |
| $17.24 | $140.86 | $70.8 |
| Minimum Established Patient Copayment | Maximum Established Patient Copayment | Typical Established Patient Copayment |
| $4.31 | $35.21 | $17.7 |
* 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% | 59.7 | |
|
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% | 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. |
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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 | - | 65.7 | |
| 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 |
|---|---|---|
| Advance Care Plan | 8% | 117 |
| Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan. | ||
| Provide Education Opportunities for New Clinicians | Yes | N/A |
| MIPS eligible clinicians acting as a preceptor for clinicians-in-training (such as medical residents/fellows, medical students, physician assistants, nurse practitioners, or clinical nurse specialists) and accepting such clinicians for clinical rotations in community practices in small, underserved, or rural areas. | ||
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.
- 620Diagnostic imaging of retina (HCPCS:92134)
- 353Eye and medical examination for diagnosis and treatment, established patient (HCPCS:92012)
- 262Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits (HCPCS:92014)
- 21Measurement of field of vision during daylight conditions (HCPCS:92083)
- 16Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits (HCPCS:92004)
- 14Photography of the retina (HCPCS:92250)
Secondary Taxonomies
The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.
| No. | Taxonomy Code | Type | Classification | Specialization | License No. | State | Primary |
|---|---|---|---|---|---|---|---|
| 1 | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | 4301106941 | MI | No | |
Taxonomy Description: an ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. | |||||||
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 |
|---|---|---|
| A16290014 | MEDICARE PIN (08) | 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 | 6 | 9 | 1 | 6 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 0 | 0 | 3 | 0 | 1 | 12 | 9 | 2 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 0 + 0 + 3 + 0 + 1 + 1 + 2 + 9 + 2 + 24 = 44 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 50 - 44 = 6 | 6 | ||||||||
The NPI number 1003016916 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 12 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1134124522 | DR. MICHAEL SCOTT SEWARD M.D. Individual | Ophthalmology | 2848 NILES RD SAINT JOSEPH, MI 49085 (269) 428-3300 |
| 1427053826 | DR. STANLEY W PLETCHER M.D. Individual | Ophthalmology | 2848 NILES RD SAINT JOSEPH, MI 49085 (269) 428-3300 |
| 1992701098 | DR. ANDREW MANONGDO WANG M.D. Individual | Ophthalmology | 2848 NILES RD SAINT JOSEPH, MI 49085 (269) 428-3300 |
| 1255781019 | LAKESHORE ANESTHESIA STAFFING LLC Organization | Nurse Anesthetist, Certified Registered | 2848 NILES RD SAINT JOSEPH, MI 49085 (269) 932-4388 |
| 1700881166 | DR. RONALD L. MCKEY M.D. Individual | Ophthalmology | 2848 NILES RD SAINT JOSEPH, MI 49085 (269) 428-3300 |
| 1306841630 | DR. DUANE ALLEN TOLSMA O.D. Individual | Optometrist | 2848 NILES RD SAINT JOSEPH, MI 49085 (269) 428-3300 |
| 1548265879 | DR. JOHN W. MAROHN O.D. Individual | Optometrist | 2848 NILES RD SAINT JOSEPH, MI 49085 (269) 428-3300 |
| 1265437370 | DR. DAVID NEAL BROWN M.D. Individual | Ophthalmology | 2848 NILES RD SAINT JOSEPH, MI 49085 (269) 428-3300 |
| 1194216937 | DR. DANIEL JAMES VAN ELK OD Individual | Optometrist | 2848 NILES RD SAINT JOSEPH, MI 49085 (269) 428-3300 |
| 1922002708 | GREAT LAKES EYE CARE PC Organization | Ophthalmology | 2848 NILES RD SAINT JOSEPH, MI 49085 (269) 428-3300 |
| 1942205315 | DR. DAVID LOCKE COOKE M.D. Individual | Ophthalmology | 2848 NILES RD SAINT JOSEPH, MI 49085 (269) 428-3300 |
| 1003273129 | GREAT LAKES SURGERY CENTER LLC Organization | Clinic/Center (Ambulatory Surgical) | 2848 NILES RD SUITE B SAINT JOSEPH, MI 49085 (269) 428-3304 |
Frequently Asked Questions
What is Dr. Benjamin Nicholson M.D., M.A. NPI number?
The NPI number assigned to this healthcare provider is 1003016916, registered as an "individual" on July 19, 2007
Where is Dr. Benjamin Nicholson M.D., M.A. located?
The provider is located at 2848 Niles Rd Saint Joseph, Mi 49085 and the phone number is (269) 428-3300
Which is Dr. Benjamin Nicholson M.D., M.A. specialty?
The provider's speciality is Ophthalmology with a focus in Retina Specialist
How many years of experience does Dr. Benjamin Nicholson M.D., M.A. have?
The provider has more than 16 years of experience. He graduated from Saint Louis University School Of Medicine in 2007.
What insurance does Dr. Benjamin Nicholson M.D., M.A. 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. Benjamin Nicholson M.D., M.A. 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. Benjamin Nicholson M.D., M.A.?
Medicare beneficiaries should expect a typical cost of $130.74 with an average copayment of $32.68 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. Benjamin Nicholson M.D., M.A.?
The most common procedures or services performed by this practitioner are: Diagnostic imaging of retina, Eye and medical examination for diagnosis and treatment, established patient, Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits, Measurement of field of vision during daylight conditions, Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits and Photography of the retina.
How do I update my NPI information?
The NPI record of Dr. Benjamin Nicholson M.D., M.A. was last updated on July 19, 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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