DR. PHILIP A NELSON MD NPI 1003868704
Physical Medicine & Rehabilitation in Milwaukee, WI

About DR. PHILIP A NELSON MD

Philip Nelson is a provider established in Milwaukee, Wisconsin and his medical specialization is Physical Medicine & Rehabilitation with more than 24 years of experience. He graduated from Indiana University School Of Medicine in 1999. The NPI number of this provider is 1003868704 and was assigned on May 2006. The practitioner's primary taxonomy code is 208100000X with license number 45712 (WI). The provider is registered as an individual and his NPI record was last updated 16 years ago.

NPI
1003868704
Provider NameDR. PHILIP A NELSON MD
Location Address1155 N MAYFAIR RD SPINE CARE CLINIC AT PLANK ROAD MILWAUKEE, WI 53226
Location Phone(414) 456-7199
Mailing Address1155 N MAYFAIR RD SPINE CARE CLINIC AT PLANK ROAD MILWAUKEE, WI 53226
GenderMale
NPI Entity TypeIndividual
Medical School NameINDIANA UNIVERSITY SCHOOL OF MEDICINE
Graduation Year1999
Is Sole Proprietor?No
Enumeration Date05-17-2006
Last Update Date07-08-2007

Philip Nelson 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.

Philip Nelson 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 .

The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 86.6, 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.



Primary Taxonomy

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.

Taxonomy Code208100000X
ClassificationPhysical Medicine & Rehabilitation
TypeAllopathic & Osteopathic Physicians
License No.45712
License StateWI
Taxonomy DescriptionPhysical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and treating patients with physical disabilities. These disabilities may arise from conditions affecting the musculoskeletal system such as neck and back pain, sports injuries, or other painful conditions affecting the limbs, such as carpal tunnel syndrome. Alternatively, the disabilities may result from neurological trauma or disease such as spinal cord injury, head injury or stroke. A physician certified in physical medicine and rehabilitation is often called a physiatrist. The primary goal of the physiatrist is to achieve maximal restoration of physical, psychological, social and vocational function through comprehensive rehabilitation. Pain management is often an important part of the role of the physiatrist. For diagnosis and evaluation, a physiatrist may include the techniques of electromyography to supplement the standard history, physical, x-ray and laboratory examinations. The physiatrist has expertise in the appropriate use of therapeutic exercise, prosthetics (artificial limbs), orthotics and mechanical and electrical devices.

Accepted Insurance

The NPI profile data indicates this provider might be enrolled and accepting health plans from the following insurance companies or healthcare programs:

  • Medicaid
  • Medicare

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

Business Address

1155 N MAYFAIR RD
SPINE CARE CLINIC AT PLANK ROAD
MILWAUKEE, WI
ZIP 53226
Phone: (414) 456-7199

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Mailing Address

1155 N MAYFAIR RD
SPINE CARE CLINIC AT PLANK ROAD
MILWAUKEE, WI
ZIP 53226


Location Map

PECOS Enrollment and Medicare Participation Status

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 ID1153339031
PECOS Enrollment IDI20060404000510
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

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% 91
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% 72
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 - 86.6
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.

  • 13Needle measurement and recording of electrical activity of muscles of arm or leg complete study (HCPCS:95886)

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
H90739MEDICARE UPIN (02)
34394500MEDICAID (05)WI

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.
1003868704
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
20031661670
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 0 + 0 + 3 + 1 + 6 + 6 + 1 + 6 + 7 + 0 + 24 = 56
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 56 = 44

The NPI number 1003868704 is valid because the calculated check digit 4 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1265483770DR. JOSEPH LAYDE MD
Individual
Psychiatry & Neurology (Psychiatry)1155 N MAYFAIR RD BEHAVIORAL HEALTH CLINIC @ TOSA
MILWAUKEE, WI 53226
(414) 805-3666
1386696029MS. LINDA MARKER APNP
Individual
Nurse Practitioner1155 N MAYFAIR RD BEHAVIORAL HEALTH CLINIC @ TOSA
MILWAUKEE, WI 53226
(414) 805-3666
1952355869MS. CHARMAINE M SINGLETARY PT
Individual
Physical Therapist1155 N MAYFAIR RD SPINE CARE CLINIC AT PLANK ROAD
MILWAUKEE, WI 53226
(414) 456-7199
1003856196MR. STEVEN C. MAJSTORAVICH PTA
Individual
Physical Therapy Assistant1155 N MAYFAIR RD
MILWAUKEE, WI 53226
(414) 805-3666
1710929096 AMY K. VALLEJO O.T.
Individual
Occupational Therapist1155 N MAYFAIR RD THE HAND CENTER
MILWAUKEE, WI 53226
(414) 955-4263
1750324570 SARAH M GAGLIANELLO MD
Individual
Family Medicine1155 N MAYFAIR RD
MILWAUKEE, WI 53226
(414) 955-5990
1003843772 STEVEN BONDOW MD
Individual
Family Medicine1155 N MAYFAIR RD PLANK ROAD CLINIC
MILWAUKEE, WI 53226
(414) 955-5990
1811001464DR. LESLIE F. MARTIN MD, MPH
Individual
Preventive Medicine (Preventive Medicine/Occupational Environmental Medicine)1155 N MAYFAIR RD
MILWAUKEE, WI 53226
(414) 805-3666
1922101229MRS. TINA LOUISE SOWINSKI OTR/L
Individual
Occupational Therapist1155 N MAYFAIR RD SUITE 200
MILWAUKEE, WI 53226
(414) 955-4263
1700987484 BRAD J. THIEL M.D.
Individual
Psychiatry & Neurology (Psychiatry)1155 N MAYFAIR RD
MILWAUKEE, WI 53226
(414) 456-8996
1992885297 JEFFREY SCOTT QUINTANA M.D.
Individual
Anesthesiology (Pain Medicine)1155 N MAYFAIR RD PAIN MANAGEMENT CLINIC
MILWAUKEE, WI 53226
(414) 955-7600
1093890717DR. KATHRYN ANN HARTMANN M.D.
Individual
Internal Medicine1155 N MAYFAIR RD
WAUWATOSA, WI 53226
(414) 456-5990
1093890717DR. KATHRYN ANN HARTMANN M.D.
Individual
Internal Medicine1155 N MAYFAIR RD
WAUWATOSA, WI 53226
(414) 456-5990
1013075720DR. MICHAEL DIMARCO JR. PSY.D.
Individual
Psychologist (Clinical)1155 N MAYFAIR RD THIRD FLOOR
MILWAUKEE, WI 53226
(414) 955-8900
1063568202DR. DANIELLE LOUISE ANDERSON M.D.
Individual
Psychiatry & Neurology (Psychiatry)1155 N MAYFAIR RD
MILWAUKEE, WI 53226
(414) 805-3666
1225254998DR. STEPHEN CHRISTOPHER MALCOM M.D.
Individual
Internal Medicine1155 N MAYFAIR RD PLANK ROAD CLINIC
MILWAUKEE, WI 53226
(414) 955-5990
1538358049DR. JONATHAN WILLIAM KANTER PH.D.
Individual
Psychologist (Clinical)1155 N MAYFAIR RD
MILWAUKEE, WI 53226
(414) 805-3666
1740453844 CARLEY NICOLE SAUTER M.D.
Individual
Physical Medicine & Rehabilitation1155 N MAYFAIR RD SPINE CARE CLINIC AT PLANK ROAD
MILWAUKEE, WI 53226
(414) 955-7199
1992967186MS. LINDA B. PIACENTINE NP
Individual
Nurse Practitioner1155 N MAYFAIR RD
MILWAUKEE, WI 53226
(414) 805-3666
1336190719DR. NANCY D CHECK MD
Individual
Psychiatry & Neurology (Psychiatry)1155 N MAYFAIR RD MCW CAMPUS CLINIC AT TOSA CENTER
MILWAUKEE, WI 53226
(414) 955-8900

Frequently Asked Questions

What is Dr. Philip Nelson MD NPI number?

The NPI number assigned to this healthcare provider is 1003868704, registered as an "individual" on May 17, 2006

Where is Dr. Philip Nelson MD located?

The provider is located at 1155 N Mayfair Rd Spine Care Clinic At Plank Road Milwaukee, Wi 53226 and the phone number is (414) 456-7199

Which is Dr. Philip Nelson MD specialty?

The provider's speciality is Physical Medicine & Rehabilitation

How many years of experience does Dr. Philip Nelson MD have?

The provider has more than 24 years of experience. He graduated from Indiana University School Of Medicine in 1999.

What insurance does Dr. Philip Nelson MD accept?

The provider might be accepting Medicaid and Medicare. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Is Dr. Philip Nelson MD registered in PECOS?

Yes, as of January 10, 2023 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a Medicare 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.

What are Dr. Philip Nelson MD Quality Ratings?

The provider has an overall high rating in the following quality measures: quality clinical practices and patient outcomes and experiences.

What are some of the services provided by Dr. Philip Nelson MD?

The most common procedures or services performed by this practitioner are: Needle measurement and recording of electrical activity of muscles of arm or leg complete study.

How do I update my NPI information?

The NPI record of Dr. Philip Nelson MD was last updated on May 17, 2006. 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]
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us at: [email protected]