DR. KOSTANDINOS TSOULFAS MD NPI 1013088277
Pain Medicine - Pain Medicine in Greenfield, WI

About DR. KOSTANDINOS TSOULFAS MD

Kostandinos Tsoulfas is a provider established in Greenfield, Wisconsin and his medical specialization is Pain Medicine with more than 21 years of experience. The NPI number of Kostandinos Tsoulfas is 1013088277 and was assigned on November 2006. The practitioner's primary taxonomy code is 208VP0000X with license number 49097-020 (WI). The provider is registered as an individual and his NPI record was last updated 9 years ago.

NPI
1013088277
Provider NameDR. KOSTANDINOS TSOULFAS MD
Location Address4131 W LOOMIS RD #300 GREENFIELD, WI 53221
Location Phone(414) 325-7246
Mailing Address4131 W LOOMIS RD #300 GREENFIELD, WI 53221
GenderMale
NPI Entity TypeIndividual
Medical School NameOTHER
Graduation Year2002
Is Sole Proprietor?No
Enumeration Date11-10-2006
Last Update Date02-24-2014

Kostandinos Tsoulfas 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.

Kostandinos Tsoulfas 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 United 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 92.4, 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: $32.03 for a new patient copayment and $24.86 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 Code208VP0000X
ClassificationPain Medicine
TypeAllopathic & Osteopathic Physicians
SpecializationPain Medicine
License No.49097-020
License StateWI
Taxonomy DescriptionPain Medicine is a primary medical specialty based on a distinct body of knowledge and a well-defined scope of clinical practice that is founded on science, research and education. It is concerned with the study of pain, the prevention of pain, and the evaluation, treatment, and rehabilitation of persons in pain. A comprehensive evaluation incorporates the physical, psychological, cognitive and socio-cultural contributions to pain. The treatment protocol may include pharmacological, invasive, behavioral, cognitive, rehabilitative and complementary strategies provided in a concurrent focused and patient specific manner. The pain medicine physician often serves the patient as a frontline physician regarding their pain, but also may serve as a consultant to other physicians, direct an interdisciplinary/multidisciplinary treatment team, conduct research, or advocate for the patient's pain care with public and private agencies. The Pain Medicine physician may work in variety of settings including office, clinic, hospital, university, or governmental/public agencies.

Business Address

DR. KOSTANDINOS TSOULFAS MD
4131 W LOOMIS RD
#300
GREENFIELD, WI
ZIP 53221
Phone: (414) 325-7246
Fax: (414) 325-3770

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Mailing Address

DR. KOSTANDINOS TSOULFAS MD
4131 W LOOMIS RD
#300
GREENFIELD, WI
ZIP 53221
Phone: (414) 325-7246
Fax: (414) 325-3770


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 ID6103929658
PECOS Enrollment IDI20070321000405
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 53221 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
$55.63 $169.16 $128.12
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$13.9 $42.29 $32.03
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
$17.46 $138.8 $99.45
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$4.36 $34.7 $24.86

* 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% 64.4
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 - 92.4
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.

  • 223Injections of substances into lower or sacral spine (HCPCS:62311)
  • 122Injections of lower or sacral spine facet joint using imaging guidance (HCPCS:64493)
  • 119Injections of lower or sacral spine facet joint using imaging guidance (HCPCS:64494)
  • 71Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 30 minutes (HCPCS:99144)
  • 46Aspiration and/or injection of large joint or joint capsule (HCPCS:20610)
  • 11Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter (HCPCS:G0431)

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. Kostandinos Tsoulfas is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
UNITED HOSPITAL SYSTEM6308 EIGHTH AVE
KENOSHA, WI 53143
(262) 656-2011Acute Care Hospitals520021

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
1207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine49097WINo

Taxonomy Description: family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

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.
1013088277
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
20230816214
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 + 6 + 2 + 1 + 4 + 24 = 53
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 53 = 77

The NPI number 1013088277 is valid because the calculated check digit 7 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
1003834755 ELIZABETH A MAJSZAK PT
Individual
Physical Therapist4131 W LOOMIS RD
GREENFIELD, WI 53221
(414) 281-5151
1710993837DR. JEROME LERNER MD
Individual
Physical Medicine & Rehabilitation4131 W LOOMIS RD SUITE 300
GREENFIELD, WI 53221
(414) 325-7246
1326245390 DENISE CHANG SADLER M.D.
Individual
Rehabilitation Practitioner4131 W LOOMIS RD STE 300
GREENFIELD, WI 53221
(414) 325-7246
1033300116 JESSICA R GERTZ PT
Individual
Physical Therapist4131 W LOOMIS RD #200
GREENFIELD, WI 53221
(414) 281-5151
1336337187LAKESHORE MEDICAL CLINIC, LTD
Organization
Durable Medical Equipment & Medical Supplies4131 W LOOMIS RD STE 110
GREENFIELD, WI 53221
(414) 281-5153
1972759470ADVANCED PAIN MANAGEMENT
Organization
Specialist4131 W LOOMIS RD SUITE 300
GREENFIELD, WI 53221
(414) 325-3713
1730336074 ERIN T AMIOT AUD
Individual
Audiologist-Hearing Aid Fitter4131 W LOOMIS RD #110
GREENFIELD, WI 53221
(414) 281-5153
1578705984MS. AILEEN ELIZABETH ROSENBERG APNP
Individual
Nurse Practitioner4131 W LOOMIS RD STE 300
GREENFIELD, WI 53221
(414) 325-7246
1114214939 ANDREW LINK DPT
Individual
Physical Therapist4131 W LOOMIS RD SUITE 110
GREENFIELD, WI 53221
(414) 281-5151
1467411546 GINA BUONO MD
Individual
Preventive Medicine (Preventive Medicine/Occupational Environmental Medicine)4131 W LOOMIS RD #110
GREENFIELD, WI 53221
(414) 281-5153
1104809961DR. SCOTT ASCHENBRENER M.D.
Individual
Anesthesiology4131 W LOOMIS RD STE 300
GREENFIELD, WI 53221
(414) 325-7246
1073580718 HANY RADWAN NOSIR MD
Individual
Anesthesiology (Pain Medicine)4131 W LOOMIS RD STE 300
GREENFIELD, WI 53221
(414) 325-7246
1417092073 MARCO ARAUJO MD
Individual
Pain Medicine (Interventional Pain Medicine)4131 W LOOMIS RD SUITE 300
GREENFIELD, WI 53221
(414) 325-7246
1730434200MRS. ROCHELLE ANN BEINE FNP-BC
Individual
Nurse Practitioner (Family)4131 W LOOMIS RD STE 300
GREENFIELD, WI 53221
(414) 325-7246
1770500431 MAZIN ELLIAS M.D.
Individual
Anesthesiology (Pain Medicine)4131 W LOOMIS RD STE 300
GREENFIELD, WI 53221
(414) 325-7246
1265544134 NANCY A SPANGLER PA-C
Individual
Physician Assistant4131 W LOOMIS RD SUITE 300
GREENFIELD, WI 53221
(414) 325-7246
1497876817MRS. CARRIE LYNN VOSS APNP
Individual
Nurse Practitioner4131 W LOOMIS RD STE 300
GREENFIELD, WI 53221
(414) 325-7246
1568653350MS. JULIE L. KARCZEWSKI APNP
Individual
Nurse Practitioner (Family)4131 W LOOMIS RD STE 300
GREENFIELD, WI 53221
(414) 325-7246
1912158106MS. LAUREN D. TRILLO PA-C
Individual
Physician Assistant4131 W LOOMIS RD STE 300
GREENFIELD, WI 53221
(414) 325-7246
1487808598 NANCY L LASSA RN
Individual
Nurse Practitioner4131 W LOOMIS RD STE 300
GREENFIELD, WI 53221
(414) 325-7246

Frequently Asked Questions

What is Dr. Kostandinos Tsoulfas MD NPI number?

The NPI number assigned to Dr. Kostandinos Tsoulfas MD is 1013088277, registered as an "individual" on November 10, 2006

Where is Dr. Kostandinos Tsoulfas MD located?

The provider is located at 4131 W Loomis Rd #300 Greenfield, Wi 53221 and the phone number is (414) 325-7246

Which is Dr. Kostandinos Tsoulfas MD specialty?

The provider's speciality is Pain Medicine

How many years of experience does Dr. Kostandinos Tsoulfas MD have?

The provider has more than 21 years of experience.

Is Dr. Kostandinos Tsoulfas 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 Dr. Kostandinos Tsoulfas MD?

Medicare beneficiaries should expect a typical cost of $128.12 with an average copayment of $32.03 for new patient appointments. Established patients should expect a typical charge of $99.45 and an average copayment of 24.86. Please review your insurance plan or contact the provider directly to determine your specific costs.

What are some of the services provided by Dr. Kostandinos Tsoulfas MD?

The most common procedures or services performed by this practitioner are: Injections of substances into lower or sacral spine, Injections of lower or sacral spine facet joint using imaging guidance, Injections of lower or sacral spine facet joint using imaging guidance, Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 30 minutes, Aspiration and/or injection of large joint or joint capsule and Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter.

Is Dr. Kostandinos Tsoulfas MD affiliated to any hospitals?

The practitioner is affiliated to the following hospitals: UNITED 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 Dr. Kostandinos Tsoulfas MD was last updated on November 10, 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]