DR. RYAN THOMAS SMITH MD NPI 1003017468

Ophthalmology in Augusta, GA

NPI 1003017468 Individual Male Years of Experience 19 Ophthalmology PECOS Enrolled Accepts Medicare Approved Payment MIPS Quality Score 95.3 Medicare Quality Reporting

NPI Profile for DR. RYAN THOMAS SMITH MD

Ryan Smith is a provider established in Augusta, Georgia and his medical specialization is ophthalmology with more than 19 years of experience. He graduated from University Of Cincinnati College Of Medicine in 2004. The NPI number of Ryan Smith is 1003017468 and was assigned on May 2007. The practitioner's primary taxonomy code is 207W00000X with license number 66645 (GA). The provider is registered as an individual and his NPI record was last updated 7 years ago.

Ryan Smith 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.

Ryan Smith 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 University Hospital.

The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 95.3, 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: age-related macular degeneration (amd): dilated macular examination, clinical data registry reporting, closing the referral loop: receipt of specialist report, diabetes: eye exam, diabetic retinopathy: communication with the physician managing ongoing diabetes care, e-prescribing, preventive care and screening: tobacco use: screening and cessation intervention, primary open-angle glaucoma (poag): optic nerve evaluation, 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, regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms., security risk analysis, support electronic referral loops by receiving and incorporating health information, support electronic referral loops by sending health information, use of decision support and standardized treatment protocols and use of high-risk medications in the elderly.

The typical physician office visit costs for Medicare beneficiaries in this area are: $32.09 for a new patient copayment and $17.36 for an established patient copayment.

NPI

1003017468

Provider NameDR. RYAN THOMAS SMITH MD
Provider Location Address1330 INTERSTATE PKWY AUGUSTA, GA 30909
Provider Mailing Address1330 INTERSTATE PKWY AUGUSTA, GA 30909
GenderMale
NPI Entity TypeIndividual
Medical School NameUNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE
Graduation Year2004
Is Sole Proprietor?No
Is Organization Subpart?N/A
Enumeration Date05-31-2007
Last Update Date05-28-2015


Primary Taxonomy

Taxonomy Code207W00000X
ClassificationOphthalmology
TypeAllopathic & Osteopathic Physicians
License No.66645
License StateGA
Taxonomy DescriptionAn 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.

Business Address

DR. RYAN THOMAS SMITH MD
1330 INTERSTATE PKWY
AUGUSTA, GA
ZIP 30909
Phone: (706) 651-2020
Fax: (706) 855-6674

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Mailing Address

DR. RYAN THOMAS SMITH MD
1330 INTERSTATE PKWY
AUGUSTA, GA
ZIP 30909
Phone: (706) 651-2020
Fax: (706) 855-6674



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 ID6406907211
PECOS Enrollment IDI20111110000713
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 30909 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
$55.19 $169.73 $128.37
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$13.79 $42.43 $32.09
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
$16.8 $138.36 $69.44
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$4.2 $34.59 $17.36

* 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% 75
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 - 95.3
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
Age-Related Macular Degeneration (AMD): Dilated Macular Examination 96% 118
Percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage AND the level of macular degeneration severity during one or more office visits within the 12 month performance period
Clinical Data Registry ReportingYesN/A
The MIPS eligible clinician is in active engagement to submit data to a clinical data registry.
Closing the Referral Loop: Receipt of Specialist Report 39% 132
Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred
Diabetes: Eye Exam 97% 1055
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 or dilated eye exam (no evidence of retinopathy) in the 12 months prior to the measurement period
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care 89% 266
Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months
e-Prescribing 94% 3761
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using CEHRT.
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 42% 69
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
Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation 85% 420
Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits within 12 months
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 94% 4916
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).
Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms.YesN/A
Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms.
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.
Support Electronic Referral Loops By Receiving and Incorporating Health Information 82% 50
For at least one electronic summary of care record received for patient encounters during the performance period for which a MIPS eligible clinician was the receiving party of a transition of care or referral, or for patient encounters during the performance period in which the MIPS eligible clinician has never before encountered the patient, the MIPS eligible clinician conducts clinical information reconciliation for medication, medication allergy, and current problem list.
Support Electronic Referral Loops By Sending Health Information 17% 387
For at least one transition of care or referral, the MIPS eligible clinician that transitions or refers their patient to another setting of care or health care provider - (1) creates a summary of care record using certified electronic health record technology (CEHRT); and (2) electronically exchanges the summary of care record.
Use of decision support and standardized treatment protocolsYesN/A
Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs.
Use of High-Risk Medications in the Elderly 0% "Inverse Quality Measure"
This is an inverse quality measure, a lower rate means the provider is rated better.
2624
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted.1) Percentage of patients who were ordered at least one high-risk medication2) Percentage of patients who were ordered at least two of the same high-risk medication

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.

  • 1056Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits (HCPCS:92014)
  • 207Eye and medical examination for diagnosis and treatment, established patient (HCPCS:92012)
  • 181Diagnostic imaging of optic nerve of eye (HCPCS:92133)
  • 139Measurement of field of vision during daylight conditions (HCPCS:92083)
  • 120Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits (HCPCS:92004)
  • 99Diagnostic imaging of retina (HCPCS:92134)
  • 33Photography of the retina (HCPCS:92250)

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. Ryan Smith is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
UNIVERSITY HOSPITAL1350 WALTON WAY
AUGUSTA, GA 30901
(706) 722-9011Acute Care Hospitals110028

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 PhysiciansOphthalmology57009416OHNo

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 Identifier Issuer
202I183712OTHER (01)GAPTAN
0388414MEDICARE PIN (08)KY
2965260MEDICAID (05)OH
P00748929OTHER (01)OHRAILROAD MEDICARE
6038333MEDICARE PIN (08)OH
6038332MEDICARE PIN (08)OH
P00725745OTHER (01)KYRAILROAD MEDICARE
6038331MEDICARE PIN (08)OH
6038334MEDICARE PIN (08)OH

NPI Validation Check Digit Calculation


The following table explains step by step the 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.
1003017468
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
20030114412
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 + 4 + 4 + 1 + 2 + 24 = 42
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
50 - 42 = 88

The NPI number 1003017468 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the same location


The following 11 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1093798993DR. BEAU GARDNER M.D.
Individual
Ophthalmology1330 INTERSTATE PKWY
AUGUSTA, GA 30909
(706) 651-2020
1184785008DR. BRADLEY ALAN BERTRAM M.D.
Individual
Ophthalmology1330 INTERSTATE PKWY
AUGUSTA, GA 30909
(706) 651-2020
1508927310DR. BRUCE ALLEN BROWN M.D.
Individual
Ophthalmology1330 INTERSTATE PKWY
AUGUSTA, GA 30909
(706) 651-2020
1457720153EYEGUYS OD'S, LLC
Organization
Optometrist1330 INTERSTATE PKWY
AUGUSTA, GA 30909
(706) 651-2020
1841588555 DOUGLAS WILLIAM ELLENBERGER OD
Individual
Optometrist1330 INTERSTATE PKWY
AUGUSTA, GA 30909
(706) 651-2020
1508027343DR. ROBERT R MORGAN O.D
Individual
Optometrist1330 INTERSTATE PKWY
AUGUSTA, GA 30909
(706) 651-2020
1063467454DR. HERBERT PETER FECHTER III MD
Individual
Ophthalmology1330 INTERSTATE PKWY
AUGUSTA, GA 30909
(706) 651-2020
1366838120DR. JAMES CONNER LOCKWOOD M.D.
Individual
Ophthalmology1330 INTERSTATE PKWY
AUGUSTA, GA 30909
(706) 651-2020
1386705069EYE PHYSICIANS AND SURGEONS OF AUGUSTA, PC
Organization
Ophthalmology1330 INTERSTATE PKWY
AUGUSTA, GA 30909
(706) 651-2020
1962087270EYE GUYS CAROLINA LLC
Organization
Optometrist1330 INTERSTATE PKWY
AUGUSTA, GA 30909
(706) 651-3905
1760111645DAVID W BOWERS ANESTHESIA SERVICES LLC
Organization
Nurse Anesthetist, Certified Registered1330 INTERSTATE PKWY
AUGUSTA, GA 30909
(706) 651-2020

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. Ryan Thomas Smith Md 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.