MS. GAYLE CLEMONS NP
NPI 1013932623
Nurse Practitioner in Worcester, MA
NPI Status: Active since July 13, 2006
Contact Information
55 LAKE AVE N
DEPARTMENT OF PULMONARY MEDICINE
WORCESTER, MA
ZIP 01655
Phone: (508) 856-3122
- Individual
- Female
- Nurse Practitioner
- Accepts Insurance
- PECOS Enrolled
About GAYLE CLEMONS
This page provides the complete NPI Profile along with additional information for Gayle Clemons, a provider established in Worcester, Massachusetts with a medical specialization in Nurse Practitioner. The healthcare provider is registered in the NPI registry with number 1013932623 assigned on July 2006. The practitioner's primary taxonomy code is 363L00000X with license number 167476 (MA). The provider is registered as an individual and her NPI record was last updated 19 years ago.
- NPI
- 1013932623
- Provider Name
- MS. GAYLE CLEMONS NP
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 55 LAKE AVE N DEPARTMENT OF PULMONARY MEDICINE WORCESTER, MA 01655
- Location Phone
- (508) 856-3122
- Mailing Address
- PO BOX 62 TURNPIKE STATION SHREWSBURY, MA 01545
- Mailing Phone
- (508) 334-8815
- Mailing Fax
- Is Sole Proprietor?
- No
- Enumeration Date
- 07-13-2006
- Last Update Date
- 07-08-2007
- Code Navigator
A nurse practitioner (NP) like Gayle Clemons is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Nurse Practitioner
- Taxonomy Code
- 363L00000X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- License No.
- 167476
- License State
- MA
- Taxonomy Description
- (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Anthem Bronze Access Blue New England HMO 6000/20%/8000 w/HSA - HMO
- Anthem Bronze Access Blue New England HMO 7000/50%/8000 w/HSA - HMO
- Anthem Bronze Access Blue New England HMO 7500/30%/10000 Value - HMO
- Anthem Bronze Access Blue New England HMO 8500/50%/9200 - HMO
- Anthem Gold Access Blue New England HMO 1000/20%/7500 - HMO
- Anthem Gold Access Blue New England HMO 2000/0%/6500 RxD - HMO
- Anthem Gold Access Blue New England HMO 2000/10%/4600 w/HSA - HMO
- Anthem Gold Access Blue New England HMO 2000/10%/7500 - HMO
- Anthem Gold Access Blue New England HMO 2000/20%/4600 w/HSA - HMO
- Anthem Gold Access Blue New England HMO 3000/0%/7500 RxD - HMO
- Anthem Gold Access Blue New England HMO 500/30%/9000 - HMO
- Anthem Platinum Access Blue New England HMO 250/10%/3500 - HMO
- Anthem Silver Access Blue New England HMO 2500/30%/10000 Value - HMO
- Anthem Silver Access Blue New England HMO 3000/30%/9000 Value - HMO
- Anthem Silver Access Blue New England HMO 3500/20%/10000 - HMO
- Anthem Silver Access Blue New England HMO 3500/20%/7250 w/HSA - HMO
- Anthem Silver Access Blue New England HMO 4000/0%/9000 - HMO
- Anthem Silver Access Blue New England HMO 4000/0%/9000 RxD - HMO
- Anthem Silver Access Blue New England HMO 4000/10%/7250 w/HSA - HMO
- Anthem Silver Access Blue New England HMO 4000/20%/8500 - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 0704377 | MEDICAID (05) | MA | |
| CL NP3442 | MEDICARE ID-TYPE UNSPECIFIED (04) | MA | |
| S64020 | MEDICARE UPIN (02) | MA |
Medicare Participation & PECOS Enrollment Status
Gayle Clemons 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.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Provider Referred Orders for Durable Medical Equipment, Devices & Supplies
The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.
Durable Medical Equipment
DME-Other DME (DE001N)
Tubing with integrated heating element for use with positive airway pressure device (HCPCS:A4604)
7 DME suppliers used 160 Medicare Claims 160 Services Paid
DME-Other DME (DE000N)
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable (HCPCS:A7003)
2 DME suppliers used 63 Medicare Claims 121 Services Paid
DME-Other DME (DE000N)
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable (HCPCS:A7005)
2 DME suppliers used 16 Medicare Claims 16 Services Paid
DME-Other DME (DE001N)
Full face mask used with positive airway pressure device, each (HCPCS:A7030)
4 DME suppliers used 109 Medicare Claims 109 Services Paid
DME-Other DME (DE001N)
Face mask interface, replacement for full face mask, each (HCPCS:A7031)
4 DME suppliers used 113 Medicare Claims 300 Services Paid
DME-Other DME (DE001N)
Cushion for use on nasal mask interface, replacement only, each (HCPCS:A7032)
6 DME suppliers used 46 Medicare Claims 240 Services Paid
DME-Other DME (DE001N)
Pillow for use on nasal cannula type interface, replacement only, pair (HCPCS:A7033)
4 DME suppliers used 37 Medicare Claims 211 Services Paid
DME-Other DME (DE001N)
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap (HCPCS:A7034)
6 DME suppliers used 82 Medicare Claims 82 Services Paid
DME-Other DME (DE001N)
Headgear used with positive airway pressure device (HCPCS:A7035)
6 DME suppliers used 103 Medicare Claims 103 Services Paid
DME-Other DME (DE001N)
Tubing used with positive airway pressure device (HCPCS:A7037)
2 DME suppliers used 26 Medicare Claims 26 Services Paid
DME-Other DME (DE001N)
Filter, disposable, used with positive airway pressure device (HCPCS:A7038)
8 DME suppliers used 175 Medicare Claims 944 Services Paid
DME-Other DME (DE001N)
Water chamber for humidifier, used with positive airway pressure device, replacement, each (HCPCS:A7046)
6 DME suppliers used 81 Medicare Claims 81 Services Paid
DME-Oxygen and Supplies (DC000N)
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing (HCPCS:E0431)
3 DME suppliers used 58 Medicare Claims 60 Services Paid
DME-Oxygen and Supplies (DC000N)
Portable oxygen contents, gaseous, 1 month's supply = 1 unit (HCPCS:E0443)
2 DME suppliers used 11 Medicare Claims 12 Services Paid
DME-Other DME (DE005N)
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) (HCPCS:E0466)
2 DME suppliers used 31 Medicare Claims 31 Services Paid
DME-Other DME (DE001N)
Humidifier, heated, used with positive airway pressure device (HCPCS:E0562)
2 DME suppliers used 31 Medicare Claims 32 Services Paid
DME-Other DME (DE000N)
Nebulizer, with compressor (HCPCS:E0570)
1 DME suppliers used 75 Medicare Claims 75 Services Paid
DME-Other DME (DE001N)
Continuous positive airway pressure (cpap) device (HCPCS:E0601)
6 DME suppliers used 112 Medicare Claims 113 Services Paid
DME-Oxygen and Supplies (DC002N)
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)
6 DME suppliers used 133 Medicare Claims 139 Services Paid
DME-Oxygen and Supplies (DC002N)
Portable oxygen concentrator, rental (HCPCS:E1392)
5 DME suppliers used 64 Medicare Claims 66 Services Paid
DME-Other DME (DE000N)
Pharmacy dispensing fee for inhalation drug(s); per 30 days (HCPCS:Q0513)
21 DME suppliers used 222 Medicare Claims 222 Services Paid
Drugs Administered Through DME
DME-Drugs Administered Through DME (DG006N)
Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms (HCPCS:J7605)
3 DME suppliers used 36 Medicare Claims 2102 Services Paid
DME-Drugs Administered Through DME (DG006N)
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg (HCPCS:J7613)
16 DME suppliers used 141 Medicare Claims 28264 Services Paid
DME-Drugs Administered Through DME (DG006N)
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme (HCPCS:J7620)
5 DME suppliers used 38 Medicare Claims 4410 Services Paid
DME-Drugs Administered Through DME (DG000N)
Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg (HCPCS:J7626)
4 DME suppliers used 46 Medicare Claims 2940 Services Paid
DME-Drugs Administered Through DME (DG006N)
Revefenacin inhalation solution, fda-approved final product, non-compounded, administered through dme, 1 microgram (HCPCS:J7677)
2 DME suppliers used 17 Medicare Claims 89250 Services Paid
Physician Visit Costs
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 01655 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $90.7
- Minimum New Patient Price $58.86
- Maximum New Patient Price $177.36
- Average New Patient Copayment $22.67
- Minimum New Patient Copayment $14.71
- Maximum New Patient Copayment $44.34
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $103.48
- Minimum Established Patient Price $19.11
- Maximum Established Patient Price $144.84
- Average Established Patient Copayment $25.87
- Minimum Established Patient Copayment $4.77
- Maximum Established Patient Copayment $36.21
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1013932623, we treat the final digit (3) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 57. The final step is to find the difference between that total and the next multiple of ten (60 - 57 = 3).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 57 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
WORCESTER, MA 01655
WORCESTER, MA 01655
WORCESTER, MA 01655
WORCESTER, MA 01655
WORCESTER, MA 01655
WORCESTER, MA 01655
WORCESTER, MA 01655
WORCESTER, MA 01655
WORCESTER, MA 01655
WORCESTER, MA 01655
WORCESTER, MA 01655
WORCESTER, MA 01655
WORCESTER, MA 01655
WORCESTER, MA 01655
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1013932623, enumerated as an "individual" on July 13, 2006.
The provider is located at 55 LAKE AVE N DEPARTMENT OF PULMONARY MEDICINE WORCESTER, MA 01655 and the phone number is (508) 856-3122.
Nurse Practitioner with taxonomy code 363L00000X.
The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield, Medicare and. Please consult your insurance carrier or call the provider to verify.
