DR. MARIO JOSEPH QUESADA M.D.
NPI 1003018086
Orthopaedic Surgery - Adult Reconstructive Orthopaedic Surgery in Brownsville, TX

NPI Status: Active since June 01, 2007

Contact Information

1201 E ALTON GLOOR BLVD
SUITE B
BROWNSVILLE, TX
ZIP 78526
Phone: (956) 544-2663
Fax: (956) 542-2366

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  • Individual
  • Male
  • Years of Experience 24
  • Orthopaedic Surgery
  • Adult Reconstructive Orthopaedic Surgery
  • PECOS Enrolled
  • Accepts Medicare Approved Payment
  • Medicare Quality Reporting

About MARIO QUESADA

Mario Quesada is a provider established in Brownsville, Texas and his medical specialization is Orthopaedic Surgery with a focus in adult reconstructive orthopaedic surgery with more than 24 years of experience. He graduated from University Of Southern California Keck School Of Medicine in 2001. The healthcare provider is registered in the NPI registry with number 1003018086 assigned on June 2007. The practitioner's primary taxonomy code is 207XS0114X with license number Q1711 (TX). The provider is registered as an individual and his NPI record was last updated one year ago.

NPI
1003018086
Provider Name
DR. MARIO JOSEPH QUESADA M.D.
Gender
Male
Entity Type
Individual
Location Address
1201 E ALTON GLOOR BLVD SUITE B BROWNSVILLE, TX 78526
Location Phone
(956) 544-2663
Location Fax
(956) 542-2366
Mailing Address
1203E ALTON GLOOR BLVD BROWNSVILLE, TX 78526
Mailing Phone
(956) 544-2663
Mailing Fax
(956) 542-2366
Medical School Name
UNIVERSITY OF SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE
Graduation Year
2001
Is Sole Proprietor?
No
Enumeration Date
06-01-2007
Last Update Date
10-25-2023
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Mario Quesada 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 and the following quality measures were reported: chronic care and preventative care management for empaneled patients, documentation of current medications in the medical record, implementation of medication management practice improvements, measurement and improvement at the practice and panel level, medication reconciliation, patient-specific education, preventive care and screening: body mass index (bmi) screening and follow-up plan, preventive care and screening: tobacco use: screening and cessation intervention, provide patient access, security risk analysis, specialized registry reporting and use of decision support and standardized treatment protocols. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries.

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

Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery

Taxonomy Code
207XS0114X
Type
Allopathic & Osteopathic Physicians
License No.
Q1711
License State
TX
Taxonomy Description
Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, adult reconstructive orthopaedic surgeons deal with reconstructive procedures such as joint arthroplasty (i.e., hip and knee), osteotomy, arthroscopy, soft-tissue reconstruction, and a variety of other adult reconstructive surgical procedures.

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)
1207XP3100XAllopathic & Osteopathic Physicians

Orthopaedic Surgery
Pediatric Orthopaedic Surgery

MD200497 (LA)
2207XS0114XAllopathic & Osteopathic Physicians

Orthopaedic Surgery
Adult Reconstructive Orthopaedic Surgery

13888 (NV)

Insurance Plans Accepted

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

  • Aetna CVS Health

    • Gold 3: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 - HMO
    • Gold 4: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 - HMO
    • Gold S: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 - HMO
    • Silver 1: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 - HMO
    • Silver 5: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 - HMO
  • Ambetter from Arizona Complete Health

    • Choice Bronze HSA - HMO
    • Choice Bronze HSA + Vision + Adult Dental - HMO
    • Clear Gold - HMO
    • Clear Gold + Vision + Adult Dental - HMO
    • Clear Silver - HMO
  • Ambetter from Arkansas Health & Wellness

    • Choice Bronze HSA (QualChoice) - POS
    • Complete Gold - PPO
    • Complete Gold + Vision + Adult Dental - PPO
    • Complete Silver - PPO
    • Complete Silver + Vision + Adult Dental - PPO
  • Ambetter from Louisiana Healthcare Connections

    • Clear Silver - EPO
    • Clear Silver + Vision + Adult Dental - EPO
    • Complete Gold - EPO
    • Complete Gold + Vision + Adult Dental - EPO
    • Elite Bronze - EPO
  • Ambetter from Superior HealthPlan

    • Ambetter Virtual Access Gold (Virtual PCP selection required) - HMO
    • Ambetter Virtual Access Silver (Virtual PCP selection required) - HMO
    • Clear Gold - EPO
    • Clear Gold + Vision + Adult Dental - EPO
    • Clear Silver - EPO
  • Ambetter of Oklahoma

    • Clear Gold - PPO
    • Clear Gold + Vision + Adult Dental - PPO
    • Clear Silver - PPO
    • Clear Silver + Vision + Adult Dental - PPO
    • Complete Silver - PPO
  • Blue Cross and Blue Shield of Texas

    • Blue Advantage Bronze HMO℠ 204 - HMO
    • Blue Advantage Bronze HMO℠ 301 - HMO
    • Blue Advantage Bronze HMO℠ 302 - HMO
    • Blue Advantage Bronze HMO℠ 707 - HMO
    • Blue Advantage Gold HMO℠ 206 - HMO
  • Imperial Insurance Companies, Inc.

    • Imperial Preferred Bronze - HMO
    • Imperial Preferred Gold - HMO
    • Imperial Preferred Gold Zero - HMO
    • Imperial Preferred Silver - HMO
    • Imperial Standard Bronze - HMO
  • Medicare

  • Medicaid


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

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
1237710MEDICAID (05)LA 

PECOS Enrollment and Medicare Participation Status

Mario Quesada 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: 9931285897

    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: I20150720002702

    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

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
Chronic Care and Preventative Care Management for Empaneled PatientsYesN/A
Proactively manage chronic and preventive care for empaneled patients that could include one or more of the following: • Provide patients annually with an opportunity for development and/or adjustment of an individualized plan of care as appropriate to age and health status, including health risk appraisal; gender, age and condition-specific preventive care services; and plan of care for chronic conditions; • Use condition-specific pathways for care of chronic conditions (e.g., hypertension, diabetes, depression, asthma and heart failure) with evidence-based protocols to guide treatment to target; such as a CDC-recognized diabetes prevention program; • Use pre-visit planning to optimize preventive care and team management of patients with chronic conditions; • Use panel support tools (registry functionality) to identify services due; • Use predictive analytical models to predict risk, onset and progression of chronic diseases; or • Use reminders and outreach (e.g., phone calls, emails, postcards, patient portals and community health workers where available) to alert and educate patients about services due; and/or routine medication reconciliation.
Documentation of Current Medications in the Medical Record 100% 2839
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
Implementation of medication management practice improvementsYesN/A
Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/or Conduct periodic, structured medication reviews.
Measurement and Improvement at the Practice and Panel LevelYesN/A
Measure and improve quality at the practice and panel level, such as the American Board of Orthopaedic Surgery (ABOS) Physician Scorecards, that could include one or more of the following: • Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice level and at the level of the care team or MIPS eligible clinician or group (panel); and/or • Use relevant data sources to create benchmarks and goals for performance at the practice level and panel level.
Medication Reconciliation 100% 856
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
Patient-Specific Education 66% 1308
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 18% 1151
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 encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 88% 534
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
Provide Patient Access 37% 1308
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information.
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 EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.
Specialized Registry ReportingYesN/A
The MIPS eligible clinician is in active engagement to submit data to specialized registry. To earn a 5 % bonus in the promoting interoperability performance category score for submitting to one or more public health or clinical data registries also attest to PI_TRANS_PHCDRR_3_MULTI.
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.

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.

  • 82

    X-ray of shoulder, minimum of 2 views (HCPCS:73030)

  • 73

    Aspiration and/or injection of large joint or joint capsule (HCPCS:20610)

  • 58

    Injection beneath the skin or into muscle for therapy, diagnosis, or prevention (HCPCS:96372)

  • 57

    X-ray of hip with pelvis, 2-3 views (HCPCS:73502)

  • 40

    X-ray of knee, 3 views (HCPCS:73562)

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. Mario Quesada is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
VALLEY BAPTIST MEDICAL CENTER- BROWNSVILLE1040 W JEFFERSON ST
BROWNSVILLE, TX 78520
(956) 544-1400Acute Care Hospitals
VALLEY REGIONAL MEDICAL CENTER100 A ALTON GLOOR
BROWNSVILLE, TX 78526
(956) 350-7000Acute Care Hospitals
DOCTORS HOSPITAL AT RENAISSANCE5501 SOUTH MCCOLL
EDINBURG, TX 78539
(956) 362-8677Acute Care Hospitals

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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.
1003018086
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
20030116016
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 + 6 + 0 + 1 + 6 + 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 1003018086 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 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1255863890 ANDREA FRAGOSO SANTANA PA-C
Individual
Physician Assistant1201 E ALTON GLOOR BLVD
BROWNSVILLE, TX 78526
(956) 542-2325
1164099693 ANDRES AVILA
Individual
Physician Assistant1201 E ALTON GLOOR BLVD
BROWNSVILLE, TX 78526
(956) 542-2325

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1003018086, enumerated in the NPI registry as an "individual" on June 01, 2007

The provider is located at 1201 E Alton Gloor Blvd Suite B Brownsville, Tx 78526 and the phone number is (956) 544-2663

The provider's speciality is Orthopaedic Surgery with taxonomy code 207XS0114X with a focus in Adult Reconstructive Orthopaedic Surgery

The provider has more than 24 years of experience. He graduated from University Of Southern California Keck School Of Medicine in 2001.

The provider might be accepting Accepts: Aetna CVS Health, Ambetter from Arizona Complete. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Yes, as of July 02, 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 most common procedures or services performed by this practitioner are: X-ray of shoulder, minimum of 2 views, Aspiration and/or injection of large joint or joint capsule, Injection beneath the skin or into muscle for therapy, diagnosis, or prevention, X-ray of hip with pelvis, 2-3 views and X-ray of knee, 3 views.

The practitioner is affiliated to the following hospital(s): VALLEY BAPTIST MEDICAL CENTER- BROWNSVILLE, VALLEY REGIONAL MEDICAL CENTER and DOCTORS HOSPITAL AT RENAISSANCE. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

This NPI record was last updated on June 01, 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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