ANOOP PORWAL MD
NPI 1053373613
Physical Medicine & Rehabilitation in Toms River, NJ

Medicare Participation & PECOS Enrollment Status

Anoop Porwal is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Anoop Porwal 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

• PECOS PAC ID: 9830156397

  What is the PECOS Associate Control ID?
  A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

• PECOS Enrollment ID: I20041216000024

  What is the Provider Enrollment ID?
  The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

• 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 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 (DE000N)

  Walker, folding, wheeled, adjustable or fixed height (HCPCS:E0143)

  2 DME suppliers used 47 Medicare Claims 47 Services Paid

• DME-Other DME (DE000N)

  Walker, heavy duty, wheeled, rigid or folding, any type (HCPCS:E0149)

  1 DME suppliers used 21 Medicare Claims 21 Services Paid

• DME-Other DME (DE000N)

  Seat attachment, walker (HCPCS:E0156)

  2 DME suppliers used 19 Medicare Claims 19 Services Paid

• DME-Other DME (DE000N)

  Commode chair, mobile or stationary, with fixed arms (HCPCS:E0163)

  2 DME suppliers used 46 Medicare Claims 46 Services Paid

• DME-Hospital Beds (DB000N)

  Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress (HCPCS:E0260)

  3 DME suppliers used 158 Medicare Claims 158 Services Paid

• DME-Hospital Beds (DB000N)

  Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress (HCPCS:E0261)

  1 DME suppliers used 25 Medicare Claims 25 Services Paid

• DME-Hospital Beds (DB000N)

  Powered pressure-reducing air mattress (HCPCS:E0277)

  1 DME suppliers used 19 Medicare Claims 19 Services Paid

• DME-Hospital Beds (DB000N)

  Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress (HCPCS:E0303)

  1 DME suppliers used 14 Medicare Claims 14 Services Paid

• DME-Other DME (DE000N)

  Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) (HCPCS:E0630)

  3 DME suppliers used 24 Medicare Claims 24 Services Paid

• DME-Wheelchairs (DD021N)

  Manual wheelchair accessory, wheel lock brake extension (handle), each (HCPCS:E0961)

  2 DME suppliers used 23 Medicare Claims 45 Services Paid

• DME-Wheelchairs (DD021N)

  Manual wheelchair accessory, anti-tipping device, each (HCPCS:E0971)

  2 DME suppliers used 32 Medicare Claims 63 Services Paid

• DME-Wheelchairs (DD021N)

  Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each (HCPCS:E0973)

  2 DME suppliers used 11 Medicare Claims 22 Services Paid

• DME-Wheelchairs (DD021N)

  Wheelchair accessory, positioning belt/safety belt/pelvic strap, each (HCPCS:E0978)

  2 DME suppliers used 12 Medicare Claims 12 Services Paid

• DME-Wheelchairs (DD000N)

  Rollabout chair, any and all types with casters 5" or greater (HCPCS:E1031)

  1 DME suppliers used 12 Medicare Claims 12 Services Paid

• DME-Other DME (DE000N)

  Transport chair, adult size, patient weight capacity up to and including 300 pounds (HCPCS:E1038)

  2 DME suppliers used 40 Medicare Claims 40 Services Paid

• DME-Wheelchairs (DD021N)

  General use wheelchair seat cushion, width less than 22 inches, any depth (HCPCS:E2601)

  2 DME suppliers used 45 Medicare Claims 45 Services Paid

• DME-Wheelchairs (DD021N)

  General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware (HCPCS:E2611)

  2 DME suppliers used 28 Medicare Claims 28 Services Paid

• DME-Wheelchairs (DD000N)

  Standard wheelchair (HCPCS:K0001)

  3 DME suppliers used 257 Medicare Claims 257 Services Paid

• DME-Wheelchairs (DD000N)

  Standard hemi (low seat) wheelchair (HCPCS:K0002)

  1 DME suppliers used 26 Medicare Claims 26 Services Paid

• DME-Wheelchairs (DD000N)

  Lightweight wheelchair (HCPCS:K0003)

  4 DME suppliers used 193 Medicare Claims 193 Services Paid

• DME-Wheelchairs (DD000N)

  Heavy duty wheelchair (HCPCS:K0006)

  1 DME suppliers used 28 Medicare Claims 28 Services Paid

• DME-Wheelchairs (DD021N)

  Elevating leg rests, pair (for use with capped rental wheelchair base) (HCPCS:K0195)

  3 DME suppliers used 163 Medicare Claims 163 Services Paid

Orthotic Devices

• DME-Orthotic Devices (DF003N)

  Below knee, molded socket, shin, sach foot, endoskeletal system (HCPCS:L5301)

  3 DME suppliers used 25 Medicare Claims 26 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity, test socket, below knee (HCPCS:L5620)

  4 DME suppliers used 40 Medicare Claims 57 Services Paid

• DME-Orthotic Devices (DF000N)

  Addition to lower extremity, test socket, above knee (HCPCS:L5624)

  3 DME suppliers used 14 Medicare Claims 23 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity, below knee, acrylic socket (HCPCS:L5629)

  3 DME suppliers used 33 Medicare Claims 34 Services Paid

• DME-Orthotic Devices (DF000N)

  Addition to lower extremity, above knee or knee disarticulation, acrylic socket (HCPCS:L5631)

  3 DME suppliers used 11 Medicare Claims 11 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity, below knee, total contact (HCPCS:L5637)

  4 DME suppliers used 40 Medicare Claims 42 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity, below knee, flexible inner socket, external frame (HCPCS:L5645)

  3 DME suppliers used 29 Medicare Claims 31 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity, below knee suction socket (HCPCS:L5647)

  2 DME suppliers used 14 Medicare Claims 14 Services Paid

• DME-Orthotic Devices (DF000N)

  Addition to lower extremity, ischial containment/narrow m-l socket (HCPCS:L5649)

  3 DME suppliers used 14 Medicare Claims 14 Services Paid

• DME-Orthotic Devices (DF000N)

  Additions to lower extremity, total contact, above knee or knee disarticulation socket (HCPCS:L5650)

  3 DME suppliers used 14 Medicare Claims 14 Services Paid

• DME-Orthotic Devices (DF000N)

  Addition to lower extremity, above knee, flexible inner socket, external frame (HCPCS:L5651)

  3 DME suppliers used 14 Medicare Claims 14 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal) (HCPCS:L5655)

  3 DME suppliers used 15 Medicare Claims 15 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity, below knee, molded distal cushion (HCPCS:L5668)

  3 DME suppliers used 14 Medicare Claims 14 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert (HCPCS:L5671)

  4 DME suppliers used 29 Medicare Claims 31 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism (HCPCS:L5673)

  3 DME suppliers used 29 Medicare Claims 60 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism (HCPCS:L5679)

  5 DME suppliers used 38 Medicare Claims 81 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each (HCPCS:L5685)

  4 DME suppliers used 24 Medicare Claims 50 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control (HCPCS:L5828)

  3 DME suppliers used 13 Medicare Claims 13 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable (HCPCS:L5845)

  3 DME suppliers used 15 Medicare Claims 15 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability (HCPCS:L5848)

  2 DME suppliers used 12 Medicare Claims 12 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type (HCPCS:L5856)

  2 DME suppliers used 12 Medicare Claims 12 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition, endoskeletal system, below knee, alignable system (HCPCS:L5910)

  4 DME suppliers used 37 Medicare Claims 38 Services Paid

• DME-Orthotic Devices (DF000N)

  Addition, endoskeletal system, above knee or hip disarticulation, alignable system (HCPCS:L5920)

  3 DME suppliers used 11 Medicare Claims 11 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) (HCPCS:L5940)

  3 DME suppliers used 28 Medicare Claims 29 Services Paid

• DME-Orthotic Devices (DF000N)

  Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) (HCPCS:L5950)

  3 DME suppliers used 14 Medicare Claims 14 Services Paid

• DME-Orthotic Devices (DF003N)

  All lower extremity prostheses, foot, flexible keel (HCPCS:L5972)

  3 DME suppliers used 12 Medicare Claims 13 Services Paid

• DME-Orthotic Devices (DF003N)

  Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source (HCPCS:L5973)

  2 DME suppliers used 11 Medicare Claims 12 Services Paid

• DME-Orthotic Devices (DF003N)

  All lower extremity prostheses, flex-walk system or equal (HCPCS:L5981)

  3 DME suppliers used 19 Medicare Claims 19 Services Paid

• DME-Orthotic Devices (DF000N)

  All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal) (HCPCS:L5986)

  2 DME suppliers used 17 Medicare Claims 17 Services Paid

• DME-Orthotic Devices (DF000N)

  Prosthetic sheath, below knee, each (HCPCS:L8400)

  5 DME suppliers used 40 Medicare Claims 240 Services Paid

• DME-Orthotic Devices (DF003N)

  Prosthetic sock, multiple ply, below knee, each (HCPCS:L8420)

  5 DME suppliers used 43 Medicare Claims 448 Services Paid

• DME-Orthotic Devices (DF000N)

  Prosthetic shrinker, below knee, each (HCPCS:L8440)

  6 DME suppliers used 34 Medicare Claims 70 Services Paid

• DME-Orthotic Devices (DF000N)

  Prosthetic shrinker, above knee, each (HCPCS:L8460)

  2 DME suppliers used 12 Medicare Claims 22 Services Paid

• DME-Orthotic Devices (DF000N)

  Prosthetic sock, single ply, fitting, below knee, each (HCPCS:L8470)

  3 DME suppliers used 36 Medicare Claims 211 Services Paid

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Aspiration and/or injection of fluid from large joint

This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.

This service was performed 41 times for 20 patients

Established patient office or other outpatient visit, 20-29 minutes

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.

This service was performed 67 times for 26 patients

Established patient office or other outpatient visit, 30-39 minutes

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.

This service was performed 58 times for 46 patients

Follow-up hospital inpatient care per day, typically 25 minutes

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.

This service was performed 24 times for 16 patients

Follow-up nursing facility visit per day, typically 10 minutes

A follow-up nursing facility visit per day typically lasts about 10 minutes. This service involves a healthcare professional checking on your health status, answering any questions you may have, and monitoring your progress. This routine check ensures your recovery is on track and any concerns are addressed promptly.

This service was performed 927 times for 204 patients

Follow-up nursing facility visit per day, typically 15 minutes

A follow-up nursing facility visit per day is a daily check-up service provided by healthcare professionals. It lasts around 15 minutes and involves assessing your health status, monitoring your recovery progress, and addressing any concerns you may have about your health or treatment.

This service was performed 2,697 times for 636 patients

Initial hospital inpatient care per day, typically 50 minutes

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

This service was performed 21 times for 20 patients

Initial nursing facility visit per day, typically 25 minutes

An initial nursing facility visit is a daily check-up to monitor your health status. This service, lasting typically 25 minutes, involves a nurse assessing your overall wellbeing, discussing concerns, and updating your care plan as needed.

This service was performed 200 times for 159 patients

Initial nursing facility visit per day, typically 35 minutes

An initial nursing facility visit per day is a service where a healthcare professional spends about 35 minutes assessing a patient's health status. This includes reviewing medical history, conducting a physical exam, and developing a care plan based on the patient's needs.

This service was performed 773 times for 662 patients

New patient office or other outpatient visit, 45-59 minutes

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.

This service was performed 57 times for 57 patients

Overall MIPS Quality Performance

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 100, 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: .

The Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS 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.

• Final Score: 100 out of 100

  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.
  
  

• Quality Score: 92.48

  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 Score: 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.

• Improvement Activities Score: 40

  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 activities measure category compromises 15% providers final MPIS scores.
  
  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.

• Cost Score: N/A

  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.

• Cost Score: N/A

  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 Quality Measures

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