APURVA PANCHOLY MD NPI 1013085174
Obstetrics & Gynecology - Female Pelvic Medicine and Reconstructive Surgery in Houston, TX

About APURVA PANCHOLY MD

Apurva Pancholy is a women's health care provider established in Houston, Texas and his medical specialization is Obstetrics & Gynecology with a focus in female pelvic medicine and reconstructive surgery with more than 27 years of experience. He graduated from University Of Miami, Lm Miller School Of Medicine in 1996. The NPI number of Apurva Pancholy is 1013085174 and was assigned on November 2006. The practitioner's primary taxonomy code is 207VF0040X with license number N7857 (TX). The provider is registered as an individual and his NPI record was last updated 3 years ago.

NPI
1013085174
Provider Name APURVA PANCHOLY MD
Location Address929 GESSNER SUITE 1300 HOUSTON, TX 77024
Location Phone(713) 456-8010
Mailing Address915 GESSNER RD STE 400 HOUSTON, TX 77024
GenderMale
NPI Entity TypeIndividual
Medical School NameUNIVERSITY OF MIAMI, LM MILLER SCHOOL OF MEDICINE
Graduation Year1996
Is Sole Proprietor?No
Enumeration Date11-30-2006
Last Update Date10-30-2019

Women's health care providers like Apurva Pancholy Md treat and diagnose diseases and conditions that affect a woman's physical and emotional health. Women's health professionals come from a variety of different specialties, including obstetrician/gynecologists, general surgeons, perinatologists, physician assistants, nurse practitioners or nurse midwives. A women's health provider might help you with family planning, breast care, pregnancy and child birth, osteoporosis, menopause, heart disease, etc.Apurva Pancholy 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.

Apurva Pancholy 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 Memorial Hermann Memorial City Hospital, Memorial Hermann - Texas Medical Center and Memorial Hermann Hospital System.

The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 76, 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: $34.81 for a new patient copayment and $18.96 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 Code207VF0040X
ClassificationObstetrics & Gynecology
TypeAllopathic & Osteopathic Physicians
SpecializationFemale Pelvic Medicine and Reconstructive Surgery
License No.N7857
License StateTX
Taxonomy DescriptionA subspecialist in Female Pelvic Medicine and Reconstructive Surgery is a physician in Urology or Obstetrics and Gynecology who, by virtue of education and training, is prepared to provide consultation and comprehensive management of women with complex benign pelvic conditions, lower urinary tract disorders, and pelvic floor dysfunction. Comprehensive management includes those diagnostic and therapeutic procedures necessary for the total care of the patient with these conditions and complications resulting from them.

Business Address

APURVA PANCHOLY MD
929 GESSNER
SUITE 1300
HOUSTON, TX
ZIP 77024
Phone: (713) 456-8010
Fax: (713) 456-8153

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Mailing Address

APURVA PANCHOLY MD
915 GESSNER RD STE 400
HOUSTON, TX
ZIP 77024
Phone: (713) 486-6160
Fax: (713) 827-7754


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 ID1557345261
PECOS Enrollment IDI20110215000428
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 77024 ZIP code area.

New Patients Office Visits Costs *
Most Utilized Procedure Code for new patients office visits: 99204
Minimum New Patient Pricing Maximum New Patient Pricing Typical New Patient Pricing
$60.64 $183.87 $139.27
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$15.16 $45.96 $34.81
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
$18.93 $150.28 $75.86
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$4.73 $37.57 $18.96

* 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% 73.7
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% 60
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% 67.8
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 - 76
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.

  • 156Automated urinalysis test (HCPCS:81003)
  • 46Ultrasound measurement of bladder capacity after voiding (HCPCS:51798)
  • 18Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope (HCPCS:52000)

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. Apurva Pancholy is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
MEMORIAL HERMANN MEMORIAL CITY HOSPITAL921 GESSNER
HOUSTON, TX 77024
(713) 242-3000Acute Care Hospitals450610
MEMORIAL HERMANN - TEXAS MEDICAL CENTER6411 FANNIN
HOUSTON, TX 77030
(713) 704-3700Acute Care Hospitals450068
MEMORIAL HERMANN HOSPITAL SYSTEM1635 NORTH LOOP WEST
HOUSTON, TX 77008
(713) 448-6796Acute Care Hospitals450184

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
1207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology35083921OHNo

Taxonomy Description: an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

2207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyN7857TXNo

Taxonomy Description: an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

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.
1013085174
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
20230810114
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 0 + 2 + 3 + 0 + 8 + 1 + 0 + 1 + 1 + 4 + 24 = 46
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
50 - 46 = 44

The NPI number 1013085174 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 4 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1720001266DR. TIMOTHY N HICKMAN M.D
Individual
Obstetrics & Gynecology (Reproductive Endocrinology)929 GESSNER STE. 2300
HOUSTON, TX 77024
(713) 465-1211
1750383014 BARBARA C SCHROEDER M.D.
Individual
Obstetrics & Gynecology929 GESSNER SUITE 1300
HOUSTON, TX 77024
(713) 486-6600
1427399856 JENNIFER REBECCA MURY N.P.-C
Individual
Nurse Practitioner (Family)929 GESSNER SUITE 1300
HOUSTON, TX 77024
(713) 486-6600
1487880035MEMORIAL HERMANN MEDICAL GROUP
Organization
Clinic/Center (Physical Therapy)929 GESSNER SUITE 1500
HOUSTON, TX 77024
(713) 338-4949

Frequently Asked Questions

What is Apurva Pancholy MD NPI number?

The NPI number assigned to Apurva Pancholy MD is 1013085174, registered as an "individual" on November 30, 2006

Where is Apurva Pancholy MD located?

The provider is located at 929 Gessner Suite 1300 Houston, Tx 77024 and the phone number is (713) 456-8010

Which is Apurva Pancholy MD specialty?

The provider's speciality is Obstetrics & Gynecology with a focus in Female Pelvic Medicine and Reconstructive Surgery

How many years of experience does Apurva Pancholy MD have?

The provider has more than 27 years of experience. He graduated from University Of Miami, Lm Miller School Of Medicine in 1996.

Is Apurva Pancholy MD 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 Apurva Pancholy MD?

Medicare beneficiaries should expect a typical cost of $139.27 with an average copayment of $34.81 for new patient appointments. Established patients should expect a typical charge of $75.86 and an average copayment of 18.96. Please review your insurance plan or contact the provider directly to determine your specific costs.

What are some of the services provided by Apurva Pancholy MD?

The most common procedures or services performed by this practitioner are: Automated urinalysis test, Ultrasound measurement of bladder capacity after voiding and Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope.

Is Apurva Pancholy MD affiliated to any hospitals?

The practitioner is affiliated to the following hospitals: MEMORIAL HERMANN MEMORIAL CITY HOSPITAL, MEMORIAL HERMANN - TEXAS MEDICAL CENTER and MEMORIAL HERMANN HOSPITAL SYSTEM. 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 Apurva Pancholy MD was last updated on November 30, 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]