DR. BENJAMIN P NICHOLSON M.D., M.A. NPI 1003016916

Ophthalmology (Retina Specialist) in Saint Joseph, MI

NPI 1003016916 Individual Male Years of Experience 15 Ophthalmology Retina Specialist PECOS Enrolled Accepts Medicare Approved Payment Medicare Quality Reporting

About BENJAMIN NICHOLSON

Benjamin Nicholson is a provider established in Saint Joseph, Michigan and his medical specialization is ophthalmology (retina specialist) with more than 15 years of experience. He graduated from Saint Louis University School Of Medicine in 2007. The NPI number of Benjamin Nicholson 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 5 years ago.

Benjamin Nicholson is enrolled in PECOS and is eligible to order or refer healthcare 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 Lakeland Hospital, St Joseph and Lakeland Hospital Watervliet.

The provider participated in Medicare's Quality Payment Program and the following quality measures were reported: care plan, diabetes: eye exam and engagement of new medicaid patients and follow-up. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries.

NPI

1003016916

Provider NameDR. BENJAMIN P NICHOLSON M.D., M.A.
Provider Location Address2848 NILES RD SAINT JOSEPH, MI 49085
Provider Mailing Address2848 NILES RD SAINT JOSEPH, MI 49085
GenderMale
NPI Entity TypeIndividual
Medical School NameSAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE
Graduation Year2007
Is Sole Proprietor?No
Is Organization Subpart?N/A
Enumeration Date07-19-2007
Last Update Date03-27-2017


Primary Taxonomy

Taxonomy Code207WX0107X
ClassificationOphthalmology
TypeAllopathic & Osteopathic Physicians
SpecializationRetina Specialist
License No.4301106941
License StateMI
Taxonomy DescriptionAn ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases.

Business Address

DR. BENJAMIN P NICHOLSON M.D., M.A.
2848 NILES RD
SAINT JOSEPH, MI
ZIP 49085
Phone: (269) 428-3300
Fax: (269) 428-5005

Get Directions


Mailing Address

DR. BENJAMIN P NICHOLSON M.D., M.A.
2848 NILES RD
SAINT JOSEPH, MI
ZIP 49085
Phone: (269) 428-3300
Fax: (269) 428-5005



Medicare Participation

Registered in PECOS? Yes 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.
PECOS PAC ID1759523723
PECOS Enrollment IDI20150603001565, 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 ImagingYes
Eligible order / refer Durable Medical EquipmentYes
Eligible order / refer Home Health Agency (HHA)Yes
Eligible order / refer Power Mobility DevicesYes

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)

Quality Reporting

The following quality measures meets 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 Rate Number of Patients
Care Plan 48% 136
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented 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
Diabetes: Eye Exam 100% 79
Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period

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. Benjamin Nicholson is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
LAKELAND HOSPITAL, ST JOSEPH1234 NAPIER AVENUE
ST JOSEPH, MI 49085
(269) 983-8300Acute Care Hospitals230021
LAKELAND HOSPITAL WATERVLIET400 MEDICAL PARK DR
WATERVLIET, MI 49098
(269) 463-3111Acute Care Hospitals230078

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
1207W00000XAllopathic & Osteopathic PhysiciansOphthalmology4301106941MINo

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
A16290014MEDICARE PIN (08)MI

Other Providers at the same location


The following 12 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1134124522DR. MICHAEL SCOTT SEWARD M.D.
Individual
Ophthalmology2848 NILES RD
SAINT JOSEPH, MI 49085
(269) 428-3300
1427053826DR. STANLEY W PLETCHER M.D.
Individual
Ophthalmology2848 NILES RD
SAINT JOSEPH, MI 49085
(269) 428-3300
1992701098DR. ANDREW MANONGDO WANG M.D.
Individual
Ophthalmology2848 NILES RD
SAINT JOSEPH, MI 49085
(269) 428-3300
1255781019LAKESHORE ANESTHESIA STAFFING LLC
Organization
Nurse Anesthetist, Certified Registered2848 NILES RD
SAINT JOSEPH, MI 49085
(269) 932-4388
1700881166DR. RONALD L. MCKEY M.D.
Individual
Ophthalmology2848 NILES RD
SAINT JOSEPH, MI 49085
(269) 428-3300
1306841630DR. DUANE ALLEN TOLSMA O.D.
Individual
Optometrist2848 NILES RD
SAINT JOSEPH, MI 49085
(269) 428-3300
1548265879DR. JOHN W. MAROHN O.D.
Individual
Optometrist2848 NILES RD
SAINT JOSEPH, MI 49085
(269) 428-3300
1265437370DR. DAVID NEAL BROWN M.D.
Individual
Ophthalmology2848 NILES RD
SAINT JOSEPH, MI 49085
(269) 428-3300
1003273129GREAT LAKES SURGERY CENTER LLC
Organization
Clinic/Center (Ophthalmologic Surgery)2848 NILES RD SUITE B
SAINT JOSEPH, MI 49085
(269) 428-3304
1194216937DR. DANIEL JAMES VAN ELK OD
Individual
Optometrist2848 NILES RD
SAINT JOSEPH, MI 49085
(269) 428-3300
1922002708GREAT LAKES EYE CARE PC
Organization
Ophthalmology2848 NILES RD
SAINT JOSEPH, MI 49085
(269) 428-3300
1942205315DR. DAVID LOCKE COOKE M.D.
Individual
Ophthalmology2848 NILES RD
SAINT JOSEPH, MI 49085
(269) 428-3300

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
The code describing 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.