DR. MONTHER HAFEZ AL-HALAWANI M.D. NPI 1013086305
Internal Medicine - Endocrinology, Diabetes & Metabolism in Brandon, FL

About DR. MONTHER HAFEZ AL-HALAWANI M.D.

Monther Al-halawani is an internist established in Brandon, Florida and his medical specialization is Internal Medicine with a focus in endocrinology, diabetes & metabolism with more than 38 years of experience. The NPI number of Monther Al-halawani is 1013086305 and was assigned on November 2006. The practitioner's primary taxonomy code is 207RE0101X with license number ME72768 (FL). The provider is registered as an individual and his NPI record was last updated 2 years ago.

NPI
1013086305
Provider NameDR. MONTHER HAFEZ AL-HALAWANI M.D.
Location Address502 CORNER DR BRANDON, FL 33511
Location Phone(813) 643-4722
Mailing Address502 CORNER DR BRANDON, FL 33511
GenderMale
NPI Entity TypeIndividual
Medical School NameOTHER
Graduation Year1985
Is Sole Proprietor?Yes
Enumeration Date11-08-2006
Last Update Date08-11-2020

An internist like Dr. Monther Hafez Al-halawani M.d. 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.Monther Al-halawani 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.

Monther Al-halawani 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 St Josephs 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 76.9, 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 provider also has detailed performance information the following quality measures: colorectal cancer screening and falls: plan of care.

The typical physician office visit costs for Medicare beneficiaries in this area are: $33.81 for a new patient copayment and $25.94 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 Code207RE0101X
ClassificationInternal Medicine
TypeAllopathic & Osteopathic Physicians
SpecializationEndocrinology, Diabetes & Metabolism
License No.ME72768
License StateFL
Taxonomy DescriptionAn internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems.

Accepted Insurance

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

  • Aetna
  • Blue Cross Blue Shield
  • Cigna
  • Medicaid
  • Medicare
  • Railroad Medicare
  • Wellcare

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

Business Address

DR. MONTHER HAFEZ AL-HALAWANI M.D.
502 CORNER DR
BRANDON, FL
ZIP 33511
Phone: (813) 643-4722
Fax: (813) 651-3280

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Mailing Address

DR. MONTHER HAFEZ AL-HALAWANI M.D.
502 CORNER DR
BRANDON, FL
ZIP 33511
Phone: (813) 643-4722
Fax: (813) 651-3280


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 ID9436341492
PECOS Enrollment IDI20101008000293
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 33511 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
$58.4 $178.79 $135.26
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$14.6 $44.69 $33.81
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
$17.74 $145.28 $103.76
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$4.43 $36.32 $25.94

* 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% 100
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% 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 - 76.9
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.

MIPS Quality Measures

The following performance measures were reported under the Merit-Based Incentive Payment System (MIPS) and Qualified Clinical Data Registry (QCDR) quality measures program.

Quality Measure Performance Number of Patients
Colorectal Cancer Screening 22% 385
Percentage of patients 50-75 years of age who had appropriate screening for colorectal cancer
Falls: Plan of Care 100% 184
Percentage of patients aged 65 years and older with a history of falls that had a plan of care for falls documented within 12 months

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.

  • 683Blood glucose (sugar) test performed by hand-held instrument (HCPCS:82962)
  • 519Ultrasound of head and neck (HCPCS:76536)
  • 518Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes (HCPCS:G0109)
  • 96Ultrasound study of arteries of both arms and legs (HCPCS:93922)
  • 70Fine needle aspiration using imaging guidance (HCPCS:10022)
  • 48Ultrasonic guidance imaging supervision and interpretation for insertion of needle (HCPCS:76942)
  • 30Ultrasound study of arteries and arterial grafts of both legs (HCPCS:93925)
  • 29Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck (HCPCS:93880)

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. Monther Al-halawani is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
ST JOSEPHS HOSPITAL3001 W MARTIN LUTHER KING JR BLVD
TAMPA, FL 33677
(813) 870-4398Acute Care Hospitals100075

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
0737733OTHER (01)FLAETNA
2300240OTHER (01)FLGHI
14637OTHER (01)FLWELLCARE
460001515OTHER (01)FLRAILROAD MEDICARE
225514OTHER (01)FLAV-MED
3300200OTHER (01)FLUNITED HEALTHCARE
593446898OTHER (01)FLTAX ID#
2962501006OTHER (01)FLCIGNA
38043OTHER (01)FLBCBS FL

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.
1013086305
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2023081230
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 + 2 + 3 + 0 + 24 = 45
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
50 - 45 = 55

The NPI number 1013086305 is valid because the calculated check digit 5 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1124336177MONTHER AL-HALAWANI, MD, PA
Organization
Specialist502 CORNER DR
BRANDON, FL 33511
(813) 643-4722

Frequently Asked Questions

What is Dr. Monther Al-halawani M.D. NPI number?

The NPI number assigned to Dr. Monther Al-halawani M.D. is 1013086305, registered as an "individual" on November 08, 2006

Where is Dr. Monther Al-halawani M.D. located?

The provider is located at 502 Corner Dr Brandon, Fl 33511 and the phone number is (813) 643-4722

Which is Dr. Monther Al-halawani M.D. specialty?

The provider's speciality is Internal Medicine with a focus in Endocrinology, Diabetes & Metabolism

How many years of experience does Dr. Monther Al-halawani M.D. have?

The provider has more than 38 years of experience.

What insurance does Dr. Monther Al-halawani M.D. accept?

The provider might be accepting Aetna, Blue Cross Blue Shield, Cigna, Medicaid, Medicare, Railroad Medicare and Wellcare. Please consult your insurance carrier or call the provider to make sure your insurance plan is currently accepted.

Is Dr. Monther Al-halawani M.D. 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 Dr. Monther Al-halawani M.D.?

Medicare beneficiaries should expect a typical cost of $135.26 with an average copayment of $33.81 for new patient appointments. Established patients should expect a typical charge of $103.76 and an average copayment of 25.94. Please review your insurance plan or contact the provider directly to determine your specific costs.

What are some of the services provided by Dr. Monther Al-halawani M.D.?

The most common procedures or services performed by this practitioner are: Blood glucose (sugar) test performed by hand-held instrument, Ultrasound of head and neck, Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes, Ultrasound study of arteries of both arms and legs, Fine needle aspiration using imaging guidance, Ultrasonic guidance imaging supervision and interpretation for insertion of needle, Ultrasound study of arteries and arterial grafts of both legs and Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck.

Is Dr. Monther Al-halawani M.D. affiliated to any hospitals?

The practitioner is affiliated to the following hospitals: ST JOSEPHS 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 Dr. Monther Al-halawani M.D. was last updated on November 08, 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]