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DR. MICHAEL DAVID MODICA M.D.
NPI 1013334069
Internal Medicine in New Orleans, LA

Active since March 26, 2014PECOS EnrolledAccepts Medicare Assignment
88.05/100
CMS Quality Rating
2021 PERDIDO ST FL 5, NEW ORLEANS, LA 70112(504) 568-5600(504) 568-7884 Get Directions Write a Review

NPPES record last updated: July 3, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 3, 2023, May 31, 2017 (2 updates tracked since 2017).

About Dr. Michael David Modica M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MICHAEL DAVID MODICA M.D. (NPI 1013334069) is an individual internal medicine provider in New Orleans, Louisiana, licensed in Louisiana (208088) and active in the NPI registry since March 2014. He is enrolled in Medicare PECOS, is affiliated with West Jefferson Medical Center, and is a graduate of Louisiana State University School Of Medicine In New Orleans (2014).

NPPES Registry Identity

NPI1013334069
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameDR. MICHAEL DAVID MODICACredential: M.D.
Location Address2021 PERDIDO ST FL 5New Orleans, LA 70112-1352
Mailing Address2021 Perdido St Fl 5New Orleans, LA 70112-1352 · (504) 568-5600 · Fax (504) 568-7884
Phone(504) 568-5600
Fax(504) 568-7884
Sole ProprietorNo
Medical School CMSLouisiana State University School Of Medicine In New OrleansGraduated 2014
Enumeration DateMarch 26, 2014
Last NPPES UpdateJuly 3, 20232 updates tracked since enumeration
NPPES CertifiedJuly 3, 2023
✔ NPI 1013334069 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in LA · 208088
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
2021 PERDIDO ST FL 5, New Orleans, LA 70112
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Other Identifiers 1

Medicaid2361490LA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HMO Louisiana.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Michael David Modica M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2163732587
PECOS Enrollment IDI20170612001484
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
158 services50 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
63 services58 patients
Hospital discharge day management, 30 minutes or less 99238
Hospital discharge day management of 30 minutes or less includes finalizing your treatment, discussing your progress, and planning after-care at home. It ensures you're ready to leave the hospital and continue recovery safely.
56 services48 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233
Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.
30 services19 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

West Jefferson Medical Center

Acute Care Hospitals · Marrero, LA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number190039
Location1101 Medical Center BlvdMarrero, LA 70072 · Jefferson County
Emergency services Birthing friendly

Touro Infirmary

Acute Care Hospitals · New Orleans, LA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number190046
Location1401 Foucher StreetNew Orleans, LA 70115 · Orleans County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 70112 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$128.88 typical visit price
range $55.50 – $170.30
Typical copayment $32.22 (range $13.87 – $42.57)
Most-billed visit code 99204
Established Patient
$98.35 typical visit price
range $17.42 – $138.03
Typical copayment $24.58 (range $4.35 – $34.50)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

88.05/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality74.6
Promoting Interoperability100
Improvement Activities40
Cost58.23

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CASSIE AMANDA SHAW MD
Internal Medicine
2021 PERDIDO ST FL 5
NEW ORLEANS, LA 70112
Orleans Parish (504) 568-4624
DR. THOMAS JASON SENDRIJAS SIMON MD
Hospitalist
2021 PERDIDO ST FL 5
NEW ORLEANS, LA 70112
Orleans Parish (504) 568-4624
EDWARD RYAN LEONARD MD
Hospitalist
2021 PERDIDO ST FL 5
NEW ORLEANS, LA 70112
Orleans Parish (504) 568-5600
MR. CHRISTOPHER LANE DIETHELM
Student in an Organized Health Care Education/Training Program
2021 PERDIDO ST FL 5
NEW ORLEANS, LA 70112
Orleans Parish (504) 568-2127

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Michael Modica's NPI number?

The NPI number for Michael Modica is 1013334069. It was assigned to this individual provider in the NPPES registry on March 26, 2014.

Where is Michael Modica located?

Michael Modica practices at 2021 Perdido St Fl 5, New Orleans, LA 70112. The listed phone number is (504) 568-5600.

What is Michael Modica's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Michael Modica enrolled in Medicare?

Yes. Michael Modica is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Michael Modica accept?

Health plans from HMO Louisiana list Michael Modica as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Michael Modica affiliated with any hospitals?

According to CMS data, Michael Modica is affiliated with West Jefferson Medical Center and Touro Infirmary.

When was this NPI record last updated?

The NPPES record for Michael Modica was last updated on July 3, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.