|Provider Name||DR. JAMES DAVID GROVE O.D.|
|Location Address||303 N MAIN ST URBANA, OH 43078|
|Location Phone||(937) 653-5228|
|Mailing Address||303 N MAIN ST URBANA, OH 43078|
|NPI Entity Type||Individual|
|Medical School Name||OHIO STATE UNIVERSITY - COLLEGE OF OPTOMETRY|
|Is Sole Proprietor?||Yes|
|Last Update Date||09-25-2019|
James Grove 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) and a Home Health Agency (HHA).
James Grove 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.
The provider participated in Medicare's Quality Payment Program and the following quality measures were reported: diabetes: eye exam. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries.
The typical physician office visit costs for Medicare beneficiaries in this area are: $32.89 for a new patient copayment and $17.8 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||Eye and Vision Services Providers|
|Taxonomy Description||Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.|
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.
DR. JAMES DAVID GROVE O.D.
303 N MAIN ST
Phone: (937) 653-5228
DR. JAMES DAVID GROVE O.D.
303 N MAIN ST
Phone: (614) 878-0361
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||1759473721|
|PECOS Enrollment ID||I20070822000801|
|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||No|
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 43078 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|
|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.
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|
|Diabetes: Eye Exam||87%||31|
|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|
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.
- 85Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits (HCPCS:92014)
- 47Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits (HCPCS:92004)
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|
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 + 4 + 4 + 4 + 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 1013092428 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 2 providers are registered at the same or nearby location.
Frequently Asked Questions
What is Dr. James Grove O.D. NPI number?
The NPI number assigned to Dr. James Grove O.D. is 1013092428, registered as an "individual" on October 25, 2006
Where is Dr. James Grove O.D. located?
The provider is located at 303 N Main St Urbana, Oh 43078 and the phone number is (937) 653-5228
Which is Dr. James Grove O.D. specialty?
The provider's speciality is Optometrist
How many years of experience does Dr. James Grove O.D. have?
The provider has more than 23 years of experience. He graduated from Ohio State University - College Of Optometry in 2000.
What insurance does Dr. James Grove O.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 Dr. James Grove O.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) and a Home Health Agency (HHA).
How much is a visit to Dr. James Grove O.D.?
Medicare beneficiaries should expect a typical cost of $131.59 with an average copayment of $32.89 for new patient appointments. Established patients should expect a typical charge of $71.2 and an average copayment of 17.8. Please review your insurance plan or contact the provider directly to determine your specific costs.
What are some of the services provided by Dr. James Grove O.D.?
The most common procedures or services performed by this practitioner are: Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits and Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits.
How do I update my NPI information?
The NPI record of Dr. James Grove O.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]