|Provider Name||JOHN TEXADA MD|
|Provider Location Address||4709 PAPERMILL DR STE 201 KNOXVILLE, TN 37909|
|Provider Mailing Address||4709 PAPERMILL DR STE 201 KNOXVILLE, TN 37909|
|NPI Entity Type||Individual|
|Medical School Name||LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS|
|Is Sole Proprietor?||No|
|Last Update Date||11-29-2016|
John Texada 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.
John Texada 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 Parkwest Medical Center, Fort Sanders Regional Medical Center, Claiborne Medical Center, Roane Medical Center and Leconte Medical Center.
The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 85.8, 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: $21.08 for a new patient copayment and $17.19 for an established patient copayment.
|Type||Allopathic & Osteopathic Physicians|
|Taxonomy Description||A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.|
JOHN TEXADA MD
4709 PAPERMILL DR STE 201
Phone: (865) 766-6870
JOHN TEXADA MD
4709 PAPERMILL DR STE 201
Phone: (865) 766-6870
PECOS Enrollment and Medicare Participation
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 ID||1355412982|
|PECOS Enrollment ID||I20090820000272, I20190318000107|
|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 Imaging||Yes|
|Eligible order / refer Durable Medical Equipment||Yes|
|Eligible order / refer Home Health Agency (HHA)||Yes|
|Eligible order / refer Power Mobility Devices||Yes|
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 37909 ZIP code area.
|New Patients Office Visits Costs *|
|Most Utilized Procedure Code for new patients office visits: 99203|
|Minimum New Patient Pricing||Maximum New Patient Pricing||Typical New Patient Pricing|
|Minimum New Patient Copayment||Maximum New Patient Copayment||Typical New Patient Copayment|
|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|
|Minimum Established Patient Copayment||Maximum Established Patient Copayment||Typical Established Patient Copayment|
* 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|
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%||N/A|
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.
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.
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||-||85.8|
|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.|
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.
- 1620X-ray of chest, 1 view, front (HCPCS:71010)
- 803X-ray of chest, 2 views, front and side (HCPCS:71020)
- 211CT scan of abdomen and pelvis (HCPCS:74176)
- 170CT scan of abdomen and pelvis with contrast (HCPCS:74177)
- 137X-ray of abdomen, single view (HCPCS:74000)
- 100X-ray of ribs of one side of body, minimum of 2 views (HCPCS:73510)
- 93Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck (HCPCS:93880)
- 85X-ray of knee, 3 views (HCPCS:73562)
- 83X-ray of foot, minimum of 3 views (HCPCS:73630)
- 60Nuclear medicine study with CT imaging skull base to mid-thigh (HCPCS:78815)
- 54X-ray of wrist, minimum of 3 views (HCPCS:73110)
- 51Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers (HCPCS:93970)
- 42X-ray of hand, minimum of 3 views (HCPCS:73130)
- 34Bone and/or joint imaging, whole body (HCPCS:78306)
- 33Ultrasound of head and neck (HCPCS:76536)
- 20Nuclear medicine study of lung ventilation and blood circulation in the lungs (HCPCS:78582)
- 19Ultrasound pelvis through vagina (HCPCS:76830)
- 16X-ray of shoulder, minimum of 2 views (HCPCS:73030)
- 16Ultrasound study of arteries and arterial grafts of both legs (HCPCS:93925)
- 11Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers (HCPCS:93971)
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. John Texada is affiliated with the following medical facilities:
|Hospital Name||Address||Phone||Hospital Type||CMS Certification Number (CCN)||Overall Rating|
|PARKWEST MEDICAL CENTER||9352 PARK WEST BLVD|
KNOXVILLE, TN 37923
|(865) 970-9800||Acute Care Hospitals||440173|
|FORT SANDERS REGIONAL MEDICAL CENTER||1901 W CLINCH AVE|
KNOXVILLE, TN 37916
|(865) 541-1101||Acute Care Hospitals||440125|
|CLAIBORNE MEDICAL CENTER||1850 OLD KNOXVILLE HIGHWAY|
TAZEWELL, TN 37879
|(423) 626-4211||Acute Care Hospitals||440057|
|ROANE MEDICAL CENTER||8045 ROANE MEDICAL CENTER DRIVE|
HARRIMAN, TN 37748
|(865) 316-1000||Acute Care Hospitals||440031|
|LECONTE MEDICAL CENTER||742 MIDDLECREEK ROAD|
SEVIERVILLE, TN 37862
|(865) 446-7500||Acute Care Hospitals||440081|
|Identifier||Type / Code||Identifier State|
|3042220||MEDICARE PIN (08)||TN|
NPI Validation Check Digit Calculation
|Step 1: Double the value of the alternate digits, beginning with the rightmost digit.|
|2 + 0 + 0 + 3 + 0 + 2 + 2 + 7 + 1 + 6 + 24 = 47|
|50 - 47 = 3||3|
The NPI number 1003021783 is valid because the calculated check digit 3 using the Luhn validation algorithm matches the last digit of the original NPI number.
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
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.
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
Entity Type Code
John Texada 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.
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.
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.
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.
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.