|Provider Name||MRS. BRENDA JOAN BAKER MD|
|Location Address||BUILDING 37 HIGHWAY 343 NEON, KY 41840|
|Location Phone||(606) 832-0192|
|Mailing Address||PO BOX 517 NEON, KY 41840|
|NPI Entity Type||Individual|
|Medical School Name||JC EDWARDS SCHOOL OF MEDICINE, MARSHALL UNIVERSITY|
|Is Sole Proprietor?||Yes|
|Last Update Date||11-20-2018|
A primary care provider (PCP) like Mrs. Brenda Joan Baker Md 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 Brenda Baker 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.
Brenda Baker 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 Whitesburg Arh Hospital and Pikeville Medical Center.
The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 39, 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 following quality measures were reported for this provider: breast cancer screening, care plan, chronic care and preventative care management for empaneled patients, colorectal cancer screening, diabetes: eye exam, documentation of current medications in the medical record, e-prescribing, implementation of medication management practice improvements, measurement and improvement at the practice and panel level, medication reconciliation, patient-specific education, preventive care and screening: body mass index (bmi) screening and follow-up plan, preventive care and screening: influenza immunization, preventive care and screening: screening for depression and follow-up plan, provide patient access, screening for osteoporosis for women aged 65-85 years of age, secure messaging, security risk analysis, specialized registry reporting, urinary incontinence: assessment of presence or absence of urinary incontinence in women aged 65 years and older and use of decision support and standardized treatment protocols.
The typical physician office visit costs for Medicare beneficiaries in this area are: $21.18 for a new patient copayment and $24.51 for an established patient copayment.
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.
|Type||Allopathic & Osteopathic Physicians|
|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.|
The NPI profile data indicates this provider might be enrolled and accepting insurance plans from the following companies or healthcare programs:
- Blue Cross Blue Shield
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
MRS. BRENDA JOAN BAKER MD
Phone: (606) 832-0192
Fax: (606) 832-0194
MRS. BRENDA JOAN BAKER MD
PO BOX 517
Phone: (606) 832-0192
Fax: (606) 832-0194
hwy 343 Building #1383
Neon, KY 41840
(606) 832-01922205 Carter Ave
Ashland, KY 41101
(606) 393-1872150 New Towne Square Suite 7
Moorehead, KY 40351
(606) 780-11111451 Diederich Blvd
Russell, KY 41169
(606) 388-2704204 S Carol Malone Blvd
Grayson, KY 41143
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 ID||244307668|
|PECOS Enrollment ID||I20080925000615|
|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 Imaging||Yes|
|Eligible order / refer Durable Medical Equipment||Yes|
|Eligible order / refer Home Health Agency (HHA)||Yes|
|Eligible order / refer Power Mobility Devices||Yes|
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 41840 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|
|Minimum New Patient Copayment||Maximum New Patient Copayment||Typical New Patient Copayment|
|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|
|Minimum Established Patient Copayment||Maximum Established Patient Copayment||Typical Established Patient Copayment|
* 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|
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%||69|
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.
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.
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||-||39|
|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.|
The following quality measures meet Medicare's statistical reporting standards for the year 2018. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.
|Quality Measure||Performance||Number of Patients|
|Breast Cancer Screening||8%||146|
|Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer|
|Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan|
|Chronic Care and Preventative Care Management for Empaneled Patients||Yes||N/A|
|Proactively manage chronic and preventive care for empaneled patients that could include one or more of the following: • Provide patients annually with an opportunity for development and/or adjustment of an individualized plan of care as appropriate to age and health status, including health risk appraisal; gender, age and condition-specific preventive care services; and plan of care for chronic conditions; • Use condition-specific pathways for care of chronic conditions (e.g., hypertension, diabetes, depression, asthma and heart failure) with evidence-based protocols to guide treatment to target; such as a CDC-recognized diabetes prevention program; • Use pre-visit planning to optimize preventive care and team management of patients with chronic conditions; • Use panel support tools (registry functionality) to identify services due; • Use predictive analytical models to predict risk, onset and progression of chronic diseases; or • Use reminders and outreach (e.g., phone calls, emails, postcards, patient portals and community health workers where available) to alert and educate patients about services due; and/or routine medication reconciliation.|
|Colorectal Cancer Screening||100%||68|
|Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer|
|Diabetes: Eye Exam||27%||124|
|Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period|
|Documentation of Current Medications in the Medical Record||99%||3463|
|Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration|
|At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.|
|Implementation of medication management practice improvements||Yes||N/A|
|Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/or Conduct periodic, structured medication reviews.|
|Measurement and Improvement at the Practice and Panel Level||Yes||N/A|
|Measure and improve quality at the practice and panel level, such as the American Board of Orthopaedic Surgery (ABOS) Physician Scorecards, that could include one or more of the following: • Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice level and at the level of the care team or MIPS eligible clinician or group (panel); and/or • Use relevant data sources to create benchmarks and goals for performance at the practice level and panel level.|
|The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.|
|The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.|
|Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan||47%||97|
|Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2|
|Preventive Care and Screening: Influenza Immunization||0%||546|
|Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization|
|Preventive Care and Screening: Screening for Depression and Follow-Up Plan||41%||87|
|Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen|
|Provide Patient Access||71%||760|
|At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information.|
|Screening for Osteoporosis for Women Aged 65-85 Years of Age||44%||32|
|Percentage of female patients aged 65-85 years of age who ever had a central dual-energy X-ray absorptiometry (DXA) to check for osteoporosis|
|For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period.|
|Security Risk Analysis||Yes||N/A|
|Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.|
|Specialized Registry Reporting||Yes||N/A|
|The MIPS eligible clinician is in active engagement to submit data to specialized registry. To earn a 5 % bonus in the promoting interoperability performance category score for submitting to one or more public health or clinical data registries also attest to PI_TRANS_PHCDRR_3_MULTI.|
|Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older||100%||34|
|Percentage of female patients aged 65 years and older who were assessed for the presence or absence of urinary incontinence within 12 months|
|Use of decision support and standardized treatment protocols||Yes||N/A|
|Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs.|
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.
- 260Injection beneath the skin or into muscle for therapy, diagnosis, or prevention (HCPCS:96372)
- 250Injection, methylprednisolone acetate, 40 mg (HCPCS:J1030)
- 48Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounter (HCPCS:G0434)
- 40Routine EKG using at least 12 leads including interpretation and report (HCPCS:93000)
- 29Urinalysis, manual test (HCPCS:81002)
- 27Insertion of needle into vein for collection of blood sample (HCPCS:36415)
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. Brenda Baker is affiliated with the following medical facilities:
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|
|010401700||OTHER (01)||FEDERAL BLACK LUNG|
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.|
|Step 1: Double the value of the alternate digits, beginning with the rightmost digit.|
|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 + 9 + 8 + 24 = 63|
|Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.|
|70 - 63 = 7||7|
The NPI number 1013088947 is valid because the calculated check digit 7 using the Luhn validation algorithm matches the last digit of the original NPI number.
Frequently Asked Questions
What is Mrs. Brenda Baker MD NPI number?
The NPI number assigned to Mrs. Brenda Baker MD is 1013088947, registered as an "individual" on November 13, 2006
Where is Mrs. Brenda Baker MD located?
The provider is located at Building 37 Highway 343 Neon, Ky 41840 and the phone number is (606) 832-0192
Which is Mrs. Brenda Baker MD specialty?
The provider's speciality is Family Medicine
How many years of experience does Mrs. Brenda Baker MD have?
The provider has more than 33 years of experience. She graduated from Jc Edwards School Of Medicine, Marshall University in 1990.
What insurance does Mrs. Brenda Baker MD accept?
The provider might be accepting Aetna, Blue Cross Blue Shield, Medicaid and Medicare. Please consult your insurance carrier or call the provider to make sure your insurance plan is currently accepted.
Is Mrs. Brenda Baker 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 Mrs. Brenda Baker MD?
Medicare beneficiaries should expect a typical cost of $84.75 with an average copayment of $21.18 for new patient appointments. Established patients should expect a typical charge of $98.06 and an average copayment of 24.51. Please review your insurance plan or contact the provider directly to determine your specific costs.
What are some of the services provided by Mrs. Brenda Baker MD?
The most common procedures or services performed by this practitioner are: Injection beneath the skin or into muscle for therapy, diagnosis, or prevention, Injection, methylprednisolone acetate, 40 mg, Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounter, Routine EKG using at least 12 leads including interpretation and report, Urinalysis, manual test and Insertion of needle into vein for collection of blood sample.
Is Mrs. Brenda Baker MD affiliated to any hospitals?
How do I update my NPI information?
The NPI record of Mrs. Brenda Baker MD was last updated on November 13, 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]