DR. BENJAMIN P NICHOLSON M.D., M.A.
NPI 1003016916
Ophthalmology - Retina Specialist in Saint Joseph, MI


Quality Rating: 91.71 out of 100 score

NPI Status: Active since July 19, 2007

Contact Information

2848 NILES RD
SAINT JOSEPH, MI
ZIP 49085
Phone: (269) 428-3300
Fax: (269) 428-5005

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  • Individual
  • Male
  • Years of Experience 17
  • 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 with a focus in retina specialist with more than 17 years of experience. He graduated from Saint Louis University School Of Medicine in 2007. The healthcare provider is registered in the NPI registry with number 1003016916 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 one year ago.

NPI
1003016916
Provider Name
DR. BENJAMIN P NICHOLSON M.D., M.A.
Gender
Male
Entity Type
Individual
Location Address
2848 NILES RD SAINT JOSEPH, MI 49085
Location Phone
(269) 428-3300
Location Fax
(269) 428-5005
Mailing Address
2848 NILES RD SAINT JOSEPH, MI 49085
Mailing Phone
(269) 428-3300
Mailing Fax
(269) 428-5005
Medical School Name
SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE
Graduation Year
2007
Is Sole Proprietor?
No
Enumeration Date
07-19-2007
Last Update Date
04-26-2023
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Benjamin Nicholson 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 91.71, 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: care plan, diabetes: eye exam and engagement of new medicaid patients and follow-up.

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.

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

Ophthalmology Retina Specialist

Taxonomy Code
207WX0107X
Type
Allopathic & Osteopathic Physicians
License No.
4301106941
License State
MI
Taxonomy Description
An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1207W00000XAllopathic & Osteopathic Physicians

Ophthalmology

4301106941 (MI)

Insurance Plans Accepted

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

  • Blue Care Network of Michigan

    • Blue Cross® Preferred HMO Bronze - HMO
    • Blue Cross® Preferred HMO Bronze Extra - HMO
    • Blue Cross® Preferred HMO Bronze Saver HSA - HMO
    • Blue Cross® Preferred HMO Bronze Secure - HMO
    • Blue Cross® Preferred HMO Gold - HMO
    • Blue Cross® Preferred HMO Gold Extra - HMO
    • Blue Cross® Preferred HMO Silver - HMO
    • Blue Cross® Preferred HMO Silver Extra - HMO
    • Blue Cross® Preferred HMO Silver Saver - HMO
    • Blue Cross® Preferred HMO Value - HMO
    • Blue Cross® Select HMO Bronze - HMO
    • Blue Cross® Select HMO Bronze Extra - HMO
    • Blue Cross® Select HMO Bronze Saver HSA - HMO
    • Blue Cross® Select HMO Bronze Secure - HMO
    • Blue Cross® Select HMO Silver - HMO
  • Blue Cross Blue Shield of Michigan Mutual Insurance Company

    • Blue Cross® Premier PPO Bronze Extra - PPO
    • Blue Cross® Premier PPO Bronze HSA - PPO
    • Blue Cross® Premier PPO Bronze Secure - PPO
    • Blue Cross® Premier PPO Gold - PPO
    • Blue Cross® Premier PPO Gold Extra - PPO
    • Blue Cross® Premier PPO Silver - PPO
    • Blue Cross® Premier PPO Silver Extra - PPO
    • Blue Cross® Premier PPO Silver Saver HSA - PPO
    • Blue Cross® Premier PPO Value - PPO
  • McLaren Health Plan Community

    • MHP Bronze - HMO
    • MHP Bronze Saver - HMO
    • MHP Bronze VCP - HMO
    • MHP Expanded Bronze Standard - HMO
    • MHP Gold - HMO
    • MHP Gold Standard - HMO
    • MHP Gold VCP - HMO
    • MHP Silver Exchange - HMO
    • MHP Silver Exchange Rewards - HMO
    • MHP Silver Exchange VCP - HMO
    • MHP Silver Standard - HMO
    • MHP Young Adult/Catastrophic - HMO
  • Priority Health

    • MyPriority Balanced Silver - HMO
    • MyPriority Premier Silver - HMO
    • MyPriority Standard Bronze - HMO
    • MyPriority Standard Bronze - Travel - HMO
    • MyPriority Standard Gold - HMO
    • MyPriority Standard Silver - HMO
    • MyPriority Standard Silver - Travel - HMO
    • MyPriority Value Bronze - HMO
    • MyPriority Value Bronze HSA - HMO

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

PECOS Enrollment and Medicare Participation Status

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.

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: 1759523723

    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: I20150603001565, I20171110001928

    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 49085 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99204

  • Average New Patient Price $130.74
  • Minimum New Patient Price $56.39
  • Maximum New Patient Price $172.8
  • Average New Patient Copayment $32.68
  • Minimum New Patient Copayment $14.09
  • Maximum New Patient Copayment $43.2

Established Patients Visit Costs *

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

  • Average Established Patient Price $70.8
  • Minimum Established Patient Price $17.24
  • Maximum Established Patient Price $140.86
  • Average Established Patient Copayment $17.7
  • Minimum Established Patient Copayment $4.31
  • Maximum Established Patient Copayment $35.21

* 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: 91.71 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: 93.45

    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: 83.27

    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
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
Engagement of New Medicaid Patients and Follow-upYesN/A
Seeing new and follow-up Medicaid patients in a timely manner, including individuals dually eligible for Medicaid and Medicare. A timely manner is defined as within 10 business days for this activity.

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.

  • 1997

    Diagnostic imaging of retina (HCPCS:92134)

  • 1529

    Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits (HCPCS:92014)

  • 158

    Eye and medical examination for diagnosis and treatment, established patient (HCPCS:92012)

  • 130

    Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits (HCPCS:92004)

  • 21

    Photography of the retina (HCPCS:92250)

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. Benjamin Nicholson is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
LAKELAND HOSPITAL, ST JOSEPH1234 NAPIER AVENUE
ST JOSEPH, MI 49085
(269) 983-8300Acute Care Hospitals

Reviews for DR. BENJAMIN P NICHOLSON M.D., M.A.

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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.
1003016916
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2003011292
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 = 66

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 13 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1255781019LAKESHORE ANESTHESIA STAFFING LLC
Organization
Nurse Anesthetist, Certified Registered2848 NILES RD
SAINT JOSEPH, MI 49085
(269) 932-4388
1942205315DR. DAVID LOCKE COOKE M.D.
Individual
Ophthalmology2848 NILES RD
SAINT JOSEPH, MI 49085
(269) 428-3300
1003273129GREAT LAKES SURGERY CENTER LLC
Organization
Clinic/Center (Ambulatory Surgical)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
1265437370DR. DAVID NEAL BROWN 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
1548265879DR. JOHN W. MAROHN O.D.
Individual
Optometrist2848 NILES RD
SAINT JOSEPH, MI 49085
(269) 428-3300
1639528599 RIKKI S ENZOR MD, PHD
Individual
Ophthalmology2848 NILES RD
SAINT JOSEPH, MI 49085
(269) 428-3300
1700881166DR. RONALD L. MCKEY M.D.
Individual
Ophthalmology2848 NILES RD
SAINT JOSEPH, MI 49085
(269) 428-3300
1801282249 JASON MIN SO MD
Individual
Ophthalmology (Retina Specialist)2848 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
1992701098DR. ANDREW MANONGDO WANG 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

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1003016916, enumerated in the NPI registry as an "individual" on July 19, 2007

The provider is located at 2848 Niles Rd Saint Joseph, Mi 49085 and the phone number is (269) 428-3300

The provider's speciality is Ophthalmology with taxonomy code 207WX0107X with a focus in Retina Specialist

The provider has more than 17 years of experience. He graduated from Saint Louis University School Of Medicine in 2007.

The provider might be accepting Accepts: Blue Care Network of Michigan, Blue Cross Blue. 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 , uses technology to exchange and make use of healthcare information.

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.

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, 1 or more visits, Eye and medical examination for diagnosis and treatment, established patient, Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits and Photography of the retina.

The practitioner is affiliated to the following hospital(s): LAKELAND HOSPITAL, ST JOSEPH. 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 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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