DR. RAJESH SEHGAL MD NPI 1003019571

Internal Medicine - Hematology & Oncology in Monroeville, PA

Individual Male Years of Experience 23 Internal Medicine Hematology & Oncology PECOS Enrolled Accepts Medicare Approved Payment MIPS Quality Score 46.5

About DR. RAJESH SEHGAL MD

Rajesh Sehgal is an internist established in Monroeville, Pennsylvania and his medical specialization is Internal Medicine with a focus in hematology & oncology with more than 23 years of experience. The NPI number of Rajesh Sehgal is 1003019571 and was assigned on June 2007. The practitioner's primary taxonomy code is 207RH0003X with license number MD432738 (PA). The provider is registered as an individual and his NPI record was last updated 8 years ago.

An internist like Dr. Rajesh Sehgal Md is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.

NPI

1003019571

Provider NameDR. RAJESH SEHGAL MD
Provider Location Address400 OXFORD DR SUITE 102 MONROEVILLE, PA 15146
Provider Mailing Address400 OXFORD DR STE 102 MONROEVILLE, PA 15146
GenderMale
NPI Entity TypeIndividual
Medical School NameOTHER
Graduation Year2000
Is Sole Proprietor?Yes
Enumeration Date06-11-2007
Last Update Date12-24-2014



Rajesh Sehgal 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.

Rajesh Sehgal 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 Magee Womens Hospital Of Upmc Health System, Upmc East, Upmc Presbyterian Shadyside, Upmc Mckeesport Hospital and Excela Health Westmoreland Regional 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 46.5, 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 typical physician office visit costs for Medicare beneficiaries in this area are: $43.51 for a new patient copayment and $25.4 for an established patient copayment.



Primary Taxonomy

Taxonomy Code207RH0003X
ClassificationInternal Medicine
TypeAllopathic & Osteopathic Physicians
SpecializationHematology & Oncology
License No.MD432738
License StatePA
Taxonomy DescriptionAn internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

Business Address

DR. RAJESH SEHGAL MD
400 OXFORD DR
SUITE 102
MONROEVILLE, PA
ZIP 15146
Phone: (412) 856-7110
Fax: (412) 856-0565

Get Directions


Mailing Address

DR. RAJESH SEHGAL MD
400 OXFORD DR STE 102
MONROEVILLE, PA
ZIP 15146
Phone: (412) 856-7110
Fax: (412) 856-0565


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 ID8426109760
PECOS Enrollment IDI20130416000020
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 15146 ZIP code area.

New Patients Office Visits Costs *
Most Utilized Procedure Code for new patients office visits: 99205
Minimum New Patient Pricing Maximum New Patient Pricing Typical New Patient Pricing
$57.02 $174.05 $174.05
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$14.25 $43.51 $43.51
Established Patients Office Visits Costs *
Most Utilized Procedure Code for established patients office visits: 99214
Minimum Established Patient Pricing Maximum Established Patient Pricing Typical Established Patient Pricing
$17.59 $142.08 $101.62
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$4.39 $35.52 $25.4

* 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% 42.4
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% 0
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% 66.5
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 - 46.5
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.

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.

  • 27Complete blood cell count (red cells, white blood cell, platelets), automated test (HCPCS:85025)
  • 22Insertion of needle into vein for collection of blood sample (HCPCS:36415)

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. Rajesh Sehgal is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
MAGEE WOMENS HOSPITAL OF UPMC HEALTH SYSTEM300 HALKET STREET
PITTSBURGH, PA 15213
(412) 641-4010Acute Care Hospitals390114
UPMC EAST2775 MOSSIDE BOULEVARD
MONROEVILLE, PA 15146
(412) 357-3000Acute Care Hospitals390328
UPMC PRESBYTERIAN SHADYSIDE200 LOTHROP STREET
PITTSBURGH, PA 15213
(412) 647-8788Acute Care Hospitals390164
UPMC MCKEESPORT HOSPITAL1500 FIFTH AVENUE
MC KEESPORT, PA 15132
(412) 664-2000Acute Care Hospitals390002
EXCELA HEALTH WESTMORELAND REGIONAL HOSPITAL532 WEST PITTSBURGH STREET
GREENSBURG, PA 15601
(724) 832-4000Acute Care Hospitals390145

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
1207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology23530WVNo

Taxonomy Description: an internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

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
P01277311OTHER (01)PARAILROAD MEDICARE
SE4262051MEDICARE PIN (08)WV
518808OTHER (01)PAHIGHMARK BLUE SHIELD
273676MEDICARE PIN (08)PA
3810015319MEDICAID (05)WV
1028239130001MEDICAID (05)PA

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.
1003019571
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
20030118514
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 + 8 + 5 + 1 + 4 + 24 = 49
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
50 - 49 = 11

The NPI number 1003019571 is valid because the calculated check digit 1 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
1558325019HEMATOLOGY ONCOLOGY ASSOCIATION
Organization
Durable Medical Equipment & Medical Supplies400 OXFORD DR SUITE 102
MONROEVILLE, PA 15146
(412) 856-7110
1528028008 VERONICA M PRATT MD
Individual
Family Medicine400 OXFORD DR SUITE 202
MONROEVILLE, PA 15146
(412) 380-5040
1023173523 JEANNE W GREEN CRNP
Individual
Nurse Practitioner (Family)400 OXFORD DR SUITE 201
MONROEVILLE, PA 15146
(412) 374-1441
1902060312 DHAVAL R MEHTA M.D.
Individual
Internal Medicine400 OXFORD DR STE 102
MONROEVILLE, PA 15146
(412) 374-1441
1477844264UPMC COMMUNITY MEDICINE INC
Organization
Non-Pharmacy Dispensing Site400 OXFORD DR SUITE 202
MONROEVILLE, PA 15146
(412) 380-5040
1477704450MRS. WENDY MARIE STEFFL PA
Individual
Physician Assistant400 OXFORD DR SUITE 102
MONROEVILLE, PA 15146
(412) 374-1441
1215262860HEALTH CENTER ASSOCIATES UPMC
Organization
Non-Pharmacy Dispensing Site400 OXFORD DR SUITE 201
MONROEVILLE, PA 15146
(412) 823-3461
1023083284 JENNIFER STASKO
Individual
Internal Medicine400 OXFORD DR SUITE 202
MONROEVILLE, PA 15146
(412) 380-5040
1184674012 KENNETH PLOWEY
Individual
Internal Medicine400 OXFORD DR SUITE 202
MONROEVILLE, PA 15146
(412) 380-5040
1730387416 MELISSA DOSCH
Individual
Internal Medicine400 OXFORD DR SUITE 202
MONROEVILLE, PA 15146
(412) 380-5040
1891786208 ANNE TILLEY
Individual
Internal Medicine400 OXFORD DR SUITE 202
MONROEVILLE, PA 15146
(412) 380-5040
1972577112 SHAWN NASEEM
Individual
Internal Medicine400 OXFORD DR SUITE 202
MONROEVILLE, PA 15146
(412) 380-5040
1790311132 JENNIFER ROSS
Individual
Physician Assistant (Medical)400 OXFORD DR SUITE 102
MONROEVILLE, PA 15146
(412) 647-2811

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. Rajesh Sehgal 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.