ERNESTO PINZON MD
NPI 1013950542
Internal Medicine - Nephrology in Sebring, FL

Q: What is Ernesto Pinzon's NPI number?

The NPI number for Ernesto Pinzon is 1013950542. It was assigned to this individual provider in the NPPES registry on June 13, 2006.

Q: What is Ernesto Pinzon's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

Q: When was this NPI record last updated?

The NPPES record for Ernesto Pinzon was last updated on February 4, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.

Active since June 13, 2006PECOS EnrolledAccepts Medicare Assignment

89.66/100

CMS Quality Rating

2950 ALT US HWY 27 S, SUITE A, SEBRING, FL 33870(863) 471-1300(863) 471-1315 Get Directions Write a Review

NPPES record last updated: February 4, 2010. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Ernesto Pinzon Md NPPES

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

ERNESTO PINZON MD (NPI 1013950542) is an individual nephrology provider in Sebring, Florida, licensed in Florida (ME69730) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS, is affiliated with Hca Florida Highlands Hospital, and is a graduate of University Central Del Caribe Escuela De Medicina (1990).

NPPES Registry Identity

NPI1013950542

Entity TypeIndividualMale

Primary Taxonomy207RN0300X

Provider Legal NameERNESTO PINZONCredential: MD

Location Address2950 ALT US HWY 27 S, SUITE ASebring, FL 33870-4973

Mailing Address2950 Alt Us Hwy 27 S, Suite ASebring, FL 33870-4973 · (863) 471-1300 · Fax (863) 471-1315

Phone(863) 471-1300

Fax(863) 471-1315

Sole ProprietorNo

Medical School CMSUniversity Central Del Caribe Escuela De MedicinaGraduated 1990

Enumeration DateJune 13, 2006

Last NPPES UpdateFebruary 4, 2010

✔ NPI 1013950542 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · NephrologyAllopathic & Osteopathic Physicians

Taxonomy Code207RN0300X

License✔ Licensed in FL · ME69730

Definition

An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.

Also ListedInternal MedicineTaxonomy 207R00000X · License ME69730 (FL)

2950 ALT US HWY 27 S, Sebring, FL 33870

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Other Identifiers 5

Other390007438Railroad Medicare

Other28315FL · Bcbs

Medicare PIN28315FL

Medicare PIN28315AFL

Medicare UPING22174

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company), Health First Commercial Plans, Inc..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

Ernesto Pinzon Md 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 ID749243590

PECOS Enrollment IDI20041111000749

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 17

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.

Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month 99490

Chronic care management services involve a healthcare professional directing clinical staff in managing your chronic conditions. This includes the first 20 minutes per month of services like medication management, care coordination, and health monitoring to help improve your health and quality of life.

2,461 services341 patients

Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month 99439

Chronic Care Management services involve regular check-ins with healthcare professionals to manage two or more chronic conditions. It includes an additional 20 minutes of clinical staff time per month, directed by a healthcare professional, to ensure optimal health management.

2,354 services276 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

1,056 services482 patients

Care management services for behavioral health conditions, 20 minutes or more clinical staff time directed by health care professional 99484

Care management for behavioral health involves a healthcare professional directing clinical staff to provide you with support for 20 minutes or more. This service can include planning your care, coordinating services, and managing your health conditions to improve your overall well-being.

711 services101 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

525 services314 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.

236 services85 patients

Advance care planning, first 30 minutes 99497

Advance care planning is a process where you discuss your healthcare preferences with your doctor. This conversation, lasting up to 30 minutes, helps ensure your wishes are respected if you're unable to communicate them in the future. It's about your care, your way.

151 services151 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

133 services133 patients

Dialysis services, 1 physician visit per month (20 years or older) 90962

Dialysis is a treatment that filters and purifies your blood using a machine. It helps keep your fluids and electrolytes in balance when the kidneys canâ€™t do their job. A physician visit once a month ensures your treatment is working effectively and adjusts it if necessary. This service is available for individuals aged 20 years and older.

97 services15 patients

Transitional care management services for problem of at least moderate complexity 99495

Transitional care management services focus on coordinating and managing your care after you leave the hospital. For moderate complexity problems, this involves managing your medications, arranging further treatments, and ensuring you have the necessary follow-ups.

80 services66 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.

79 services72 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

65 services65 patients

Telephone medical discussion with physician, 11-20 minutes 99442

This is a service where you have a phone conversation with your doctor for 11-20 minutes. It's used for discussing health concerns, reviewing test results, or managing ongoing conditions. It's a convenient way to receive medical advice without an in-person visit.

59 services47 patients

Critical care, first 30-74 minutes 99291

Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.

45 services18 patients

Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and G0180

This is a service where a doctor or authorized practitioner certifies that you require Medicare-covered home health services. They will communicate with the home health agency and review reports on your health status to ensure you receive appropriate care. This does not involve an in-person visit.

35 services29 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

30 services30 patients

Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit G0438

An annual wellness visit is a yearly appointment with your doctor to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's an opportunity to discuss your health status and goals and get a plan tailored for you.

16 services16 patients

Hospital Affiliations CMS Care Compare 3

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

Hca Florida Highlands Hospital

Acute Care Hospitals · Sebring, FL

1/5 CMS rating

OwnershipProprietary

CMS Certification Number100049

Location3600 S Highlands AveSebring, FL 33870 · Highlands County

Emergency services

Adventhealth Sebring

Acute Care Hospitals · Sebring, FL

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number100109

Location4200 Sun N Lake BlvdSebring, FL 33872 · Highlands County

Emergency services Birthing friendly

Adventhealth Wauchula

Critical Access Hospitals · Wauchula, FL

OwnershipVoluntary non-profit - Private

CMS Certification Number101300

Location735 S 5th AveWauchula, FL 33873 · Hardee County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 33870 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

$130.04 typical visit price

range $56.00 – $171.84

Typical copayment $32.51 (range $14.00 – $42.96)

Most-billed visit code 99204

Established Patient

$99.16 typical visit price

range $17.57 – $139.16

Typical copayment $24.79 (range $4.39 – $34.79)

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.

89.66/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Individually scored

Quality

86.04

Improvement Activities

Cost

67.48

Reported Quality Measures

Advance Care Plan

29%1,244 patients2/55-star benchmark: 100%

Closing the Referral Loop: Receipt of Specialist Report

31%545 patients2/55-star benchmark: 87%

Colorectal Cancer Screening

37%705 patients2/55-star benchmark: 88%

Controlling High Blood Pressure

77%770 patients4/55-star benchmark: 91%

Coronary Artery Disease (CAD): Antiplatelet Therapy

88%157 patients4/55-star benchmark: 100%

Diabetes: Eye Exam

0%300 patients1/55-star benchmark: 100%

Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)

Lower rates are better for this measure.

59%300 patients2/55-star benchmark: 91%

Documentation of Current Medications in the Medical Record

93%4,059 patients4/55-star benchmark: 100%

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

89%1,375 patients4/55-star benchmark: 98%

Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

23%1,467 patients2/55-star benchmark: 61%

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Patients screened: 24% · 1,130 patients

23%1,130 patients

Screening for Osteoporosis for Women Aged 65-85 Years of Age

37%418 patients2/55-star benchmark: 98%

Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

87%519 patients4/55-star benchmark: 91%

Use of High-Risk Medications in Older Adults

Lower rates are better for this measure.

Patients appropriateDiagnosis: 1% · 994 patients

Patients totalRate: 10% · 1,034 patients

10%1,034 patients4/55-star benchmark: 100%

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 21

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each A4233

DME-Other DME · category DE017N

2 suppliers13 claims26 services$0.45 avg. paid by Medicare

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253

DME-Other DME · category DE017N

14 suppliers66 claims267 services$7.00 avg. paid by Medicare

Normal, low and high calibrator solution / chips A4256

DME-Other DME · category DE000N

3 suppliers39 claims39 services$2.94 avg. paid by Medicare

Spring-powered device for lancet, each A4258

DME-Other DME · category DE000N

3 suppliers15 claims15 services$1.83 avg. paid by Medicare

Lancets, per box of 100 A4259

DME-Medical/Surgical Supplies · category DA000N

9 suppliers48 claims104 services$1.18 avg. paid by Medicare

Face mask interface, replacement for full face mask, each A7031