|Provider Name||KELLY A KINSLEY M.D.|
|Location Address||4715 VALLEY EAST BLVD SUITE 3 ARCATA, CA 95521|
|Location Phone||(707) 822-3376|
|Mailing Address||1575 S RAILROAD AVE CRESCENT CITY, CA 95531|
|NPI Entity Type||Individual|
|Medical School Name||LOMA LINDA UNIVERSITY SCHOOL OF MEDICINE|
|Is Sole Proprietor?||No|
|Last Update Date||02-23-2017|
A dermatologist like Kelly A Kinsley M.d. is a medical specialty involving the management of skin conditions and diseases. Dermatologists diagnose some sexually transmitted diseases, warts, cancer, acne, dermatitis and may offer cosmetic treatments, and therapies that reduce age spots and wrinkles.Kelly Kinsley 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.
Kelly Kinsley 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 Mad River Community 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 94.4, 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 provider also has detailed performance information the following quality measures: advance care plan, biopsy follow-up, documentation of current medications in the medical record, melanoma: continuity of care - recall system, melanoma: coordination of care, one-time screening for hepatitis c virus (hcv) for patients at risk, pain assessment and follow-up, pneumococcal vaccination status for older adults, preventive care and screening: body mass index (bmi) screening and follow-up plan, preventive care and screening: unhealthy alcohol use: screening & brief counseling and provide 24/7 access to mips eligible clinicians or groups who have real-time access to patient's medical record.
The typical physician office visit costs for Medicare beneficiaries in this area are: $23.31 for a new patient copayment and $19.02 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||A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.|
The NPI profile data indicates this provider might be enrolled and accepting insurance plans from the following companies or healthcare programs:
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
KELLY A KINSLEY M.D.
4715 VALLEY EAST BLVD
Phone: (707) 822-3376
Fax: (707) 822-5053
KELLY A KINSLEY M.D.
1575 S RAILROAD AVE
CRESCENT CITY, CA
Phone: (707) 822-3376
Fax: (707) 822-5053
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||8123939071|
|PECOS Enrollment ID||I20070710000474|
|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 95521 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: 99213|
|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%||N/A|
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||-||94.4|
|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.|
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|
|Advance Care Plan||85%||2217|
|Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation 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|
|Percentage of new patients whose biopsy results have been reviewed and communicated to the primary care/referring physician and patient|
|Documentation of Current Medications in the Medical Record||11%||7159|
|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|
|Melanoma: Continuity of Care - Recall System||99%||420|
|Percentage of patients, regardless of age, with a current diagnosis of melanoma or a history of melanoma whose information was entered, at least once within a 12 month period, into a recall system that includes:- A target date for the next complete physical skin exam, AND- A process to follow up with patients who either did not make an appointment within the specified timeframe or who missed a scheduled appointment|
|Melanoma: Coordination of Care||2%||50|
|Percentage of patient visits, regardless of age, with a new occurrence of melanoma that have a treatment plan documented in the chart that was communicated to the physician(s) providing continuing care within one month of diagnosis|
|One-Time Screening for Hepatitis C Virus (HCV) for Patients at Risk||0%||1110|
|Percentage of patients aged 18 years and older with one or more of the following: a history of injection drug use, receipt of a blood transfusion prior to 1992, receiving maintenance hemodialysis, OR birthdate in the years 1945-1965 who received one-time screening for hepatitis C virus (HCV) infection|
|Pain Assessment and Follow-Up||0%||7159|
|Percentage of visits for patients aged 18 years and older with documentation of a pain assessment using a standardized tool(s) on each visit AND documentation of a follow-up plan when pain is present|
|Pneumococcal Vaccination Status for Older Adults||55%||2217|
|Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine|
|Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan||37%||4462|
|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 encounterNormal Parameters: Age 18 years and older BMI => 18.5 and < 25 kg/m2|
|Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling||7%||1906|
|Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 24 months AND who received brief counseling if identified as an unhealthy alcohol user|
|Provide 24/7 Access to MIPS Eligible Clinicians or Groups Who Have Real-Time Access to Patient's Medical Record||Yes||N/A|
|- Provide 24/7 access to MIPS eligible clinicians, groups, or care teams for advice about urgent and emergent care (e.g., MIPS eligible clinician and care team access to medical record, cross-coverage with access to medical record, or protocol-driven nurse line with access to medical record) that could include one or more of the following:- Expanded hours in evenings and weekends with access to the patient medical record (e.g., coordinate with small practices to provide alternate hour office visits and urgent care);- Use of alternatives to increase access to care team by MIPS eligible clinicians and groups, such as e-visits, phone visits, group visits, home visits and alternate locations (e.g., senior centers and assisted living centers); and/orProvision of same-day or next-day access to a consistent MIPS eligible clinician, group or care team when needed for urgent care or transition management.|
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.
- 6596Destruction of 2-14 skin growths (HCPCS:17003)
- 1619Destruction of skin growth (HCPCS:17000)
- 911Biopsy of single growth of skin and/or tissue (HCPCS:11100)
- 315Biopsy of each additional growth of skin and/or tissue (HCPCS:11101)
- 270Destruction of up to 14 skin growths (HCPCS:17110)
- 152Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (HCPCS:13132)
- 120Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips (HCPCS:11642)
- 77Injection, triamcinolone acetonide, not otherwise specified, 10 mg (HCPCS:J3301)
- 12Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips (HCPCS:14060)
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. Kelly Kinsley is affiliated with the following medical facilities:
|Hospital Name||Address||Phone||Hospital Type||CMS Certification Number (CCN)||Overall Rating|
|MAD RIVER COMMUNITY HOSPITAL||3800 JANES RD|
ARCATA, CA 95521
|(707) 822-3621||Acute Care Hospitals||50028|
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|
|F22735||MEDICARE UPIN (02)||MI|
|00G776001||MEDICARE OSCAR/CERTIFICATION (06)||CA|
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 + 9 + 2 + 9 + 1 + 0 + 24 = 52|
|Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.|
|60 - 52 = 8||8|
The NPI number 1013091958 is valid because the calculated check digit 8 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|
|1235370156||MR. EDWARD HENRY PARKER |
|Physician Assistant||4715 VALLEY EAST BLVD SUITE 3|
ARCATA, CA 95521
Frequently Asked Questions
What is Kelly Kinsley M.D. NPI number?
The NPI number assigned to Kelly Kinsley M.D. is 1013091958, registered as an "individual" on October 25, 2006
Where is Kelly Kinsley M.D. located?
The provider is located at 4715 Valley East Blvd Suite 3 Arcata, Ca 95521 and the phone number is (707) 822-3376
Which is Kelly Kinsley M.D. specialty?
The provider's speciality is Dermatology
How many years of experience does Kelly Kinsley M.D. have?
The provider has more than 33 years of experience. He graduated from Loma Linda University School Of Medicine in 1990.
What insurance does Kelly Kinsley M.D. accept?
The provider might be accepting Medicaid and Medicare. Please consult your insurance carrier or call the provider to make sure your insurance plan is currently accepted.
Is Kelly Kinsley 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 Kelly Kinsley M.D.?
Medicare beneficiaries should expect a typical cost of $93.25 with an average copayment of $23.31 for new patient appointments. Established patients should expect a typical charge of $76.09 and an average copayment of 19.02. Please review your insurance plan or contact the provider directly to determine your specific costs.
What are some of the services provided by Kelly Kinsley M.D.?
The most common procedures or services performed by this practitioner are: Destruction of 2-14 skin growths, Destruction of skin growth, Biopsy of single growth of skin and/or tissue, Biopsy of each additional growth of skin and/or tissue, Destruction of up to 14 skin growths, Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet, Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips, Injection, triamcinolone acetonide, not otherwise specified, 10 mg and Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips.
Is Kelly Kinsley M.D. affiliated to any hospitals?
The practitioner is affiliated to the following hospitals: MAD RIVER COMMUNITY 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 Kelly Kinsley M.D. was last updated on October 25, 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]