LORI L GUSHUE PA-C NPI 1013076892
Physician Assistant in Scottsdale, AZ

About LORI L GUSHUE PA-C

Lori Gushue is a primary care provider established in Scottsdale, Arizona and her medical specialization is Physician Assistant with more than 17 years of experience. The NPI number of Lori Gushue is 1013076892 and was assigned on December 2006. The practitioner's primary taxonomy code is 363A00000X with license number 3578 (AZ). The provider is registered as an individual and her NPI record was last updated 2 years ago.

NPI
1013076892
Provider Name LORI L GUSHUE PA-C
Location Address13400 E SHEA BLVD SCOTTSDALE, AZ 85259
Location Phone(480) 301-8000
Mailing Address13400 E SHEA BLVD SCOTTSDALE, AZ 85259
GenderFemale
NPI Entity TypeIndividual
Medical School NameOTHER
Graduation Year2006
Is Sole Proprietor?No
Enumeration Date12-07-2006
Last Update Date09-03-2020

A primary care provider (PCP) like Lori L Gushue Pa-c sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc Lori Gushue 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.

Lori Gushue 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 she has hospital affiliations with Mayo Clinic 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 87.7, 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: $22.08 for a new patient copayment and $17.96 for an established patient copayment.



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 Code363A00000X
ClassificationPhysician Assistant
TypePhysician Assistants & Advanced Practice Nursing Providers
License No.3578
License StateAZ
Taxonomy DescriptionA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Business Address

LORI L GUSHUE PA-C
13400 E SHEA BLVD
SCOTTSDALE, AZ
ZIP 85259
Phone: (480) 301-8000

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Mailing Address

LORI L GUSHUE PA-C
13400 E SHEA BLVD
SCOTTSDALE, AZ
ZIP 85259
Phone: (480) 301-8000


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 ID7012011240
PECOS Enrollment IDI20070328000498
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 85259 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
$57.31 $174.67 $88.33
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$14.32 $43.66 $22.08
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
$17.74 $142.64 $71.86
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$4.43 $35.66 $17.96

* 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% 90.6
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% 73
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% 80.8
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 - 87.7
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.

  • 12Harvest of veins for coronary artery bypass procedure using an endoscope (HCPCS:33508)
  • 11Heart artery bypass to repair one artery (HCPCS:33533)

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. Lori Gushue is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
MAYO CLINIC HOSPITAL5777 EAST MAYO BOULEVARD
PHOENIX, AZ 85054
(480) 342-4201Acute Care Hospitals30103

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.
1013076892
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
20230712818
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 0 + 2 + 3 + 0 + 7 + 1 + 2 + 8 + 1 + 8 + 24 = 58
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 58 = 22

The NPI number 1013076892 is valid because the calculated check digit 2 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
1457356727MRS. REBEKAH A REINKE PA-C
Individual
Physician Assistant (Medical)13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1811979750 BYRON LUCIA P.A.-C.
Individual
Physician Assistant (Surgical)13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1730161605DR. DUANE F HURST PH.D.
Individual
Psychologist (Clinical)13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1699757575 CONSTANCE WEBER RD
Individual
Dietitian, Registered13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1386626067 DOUGLAS M PETERSON M.D.
Individual
Internal Medicine13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1033191788 DAVID OSBORNE PH.D.
Individual
Psychologist (Clinical)13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1003898834 RUSSELL S RUZICH M.D.
Individual
Internal Medicine (Cardiovascular Disease)13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1124000989 ROBERT T HURST M.D.
Individual
Internal Medicine (Cardiovascular Disease)13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1336121771DR. JAMES W WILLIAMS M.D.
Individual
Pathology (Anatomic Pathology & Clinical Pathology)13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1417939828DR. DAVID W HANSON M.D.
Individual
Internal Medicine13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1972585396 STACIE E DEMENT P.A.-C.
Individual
Physician Assistant (Surgical)13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1184607467 KATHRYN M LINDBERG N.P.
Individual
Nurse Practitioner13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1356324644DR. GEORGE E BURDICK M.D.
Individual
Internal Medicine (Gastroenterology)13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1235112640 PAULA DYHRKOPP AU.D.
Individual
Audiologist13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1922081017DR. JEFFREY T LUND M.D.
Individual
Radiology (Diagnostic Radiology)13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1790768810 ROBERT L ROGERS P.A.-C.
Individual
Physician Assistant (Medical)13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1558344580DR. STEPHEN F NOLL M.D.
Individual
Physical Medicine & Rehabilitation13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1154304921DR. MARK V DAHL M.D.
Individual
Dermatology13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1508849357 JOHN P CREASMAN M.D.
Individual
Ophthalmology13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000
1609859370 SUSAN D LAMAN M.D.
Individual
Dermatology13400 E SHEA BLVD
SCOTTSDALE, AZ 85259
(480) 301-8000

Frequently Asked Questions

What is Lori Gushue PA-C NPI number?

The NPI number assigned to Lori Gushue PA-C is 1013076892, registered as an "individual" on December 07, 2006

Where is Lori Gushue PA-C located?

The provider is located at 13400 E Shea Blvd Scottsdale, Az 85259 and the phone number is (480) 301-8000

Which is Lori Gushue PA-C specialty?

The provider's speciality is Physician Assistant

How many years of experience does Lori Gushue PA-C have?

The provider has more than 17 years of experience.

Is Lori Gushue PA-C registered in PECOS?

Yes, as of November 14, 2022 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.

How much is a visit to Lori Gushue PA-C?

Medicare beneficiaries should expect a typical cost of $88.33 with an average copayment of $22.08 for new patient appointments. Established patients should expect a typical charge of $71.86 and an average copayment of 17.96. Please review your insurance plan or contact the provider directly to determine your specific costs.

What are some of the services provided by Lori Gushue PA-C?

The most common procedures or services performed by this practitioner are: Harvest of veins for coronary artery bypass procedure using an endoscope and Heart artery bypass to repair one artery.

Is Lori Gushue PA-C affiliated to any hospitals?

The practitioner is affiliated to the following hospitals: MAYO CLINIC HOSPITAL. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

How do I update my NPI information?

The NPI record of Lori Gushue PA-C was last updated on December 07, 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]