ANTONIO PEDROZA MD NPI 1063426344
Family Medicine in Renton, WA

About ANTONIO PEDROZA MD

Antonio Pedroza is a primary care provider established in Renton, Washington and his medical specialization is Family Medicine with more than 43 years of experience. He graduated from University Of Nevada School Of Medicine in 1980. The NPI number of Antonio Pedroza is 1063426344 and was assigned on July 2006. The practitioner's primary taxonomy code is 207Q00000X with license number MD00025990 (WA). The provider is registered as an individual and his NPI record was last updated 13 years ago.

NPI
1063426344
Provider Name ANTONIO PEDROZA MD
Location Address3915 TALBOT RD S STE 401 RENTON, WA 98055
Location Phone(425) 656-4224
Mailing Address3600 LIND AVE SW STE 100 RENTON, WA 98055
GenderMale
NPI Entity TypeIndividual
Medical School NameUNIVERSITY OF NEVADA SCHOOL OF MEDICINE
Graduation Year1980
Is Sole Proprietor?No
Enumeration Date07-29-2006
Last Update Date07-28-2010

A primary care provider (PCP) like Antonio Pedroza Md sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc Antonio Pedroza 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.

Antonio Pedroza 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. According to Medicare claims data he has hospital affiliations with .

The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 95.2, 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 typical physician office visit costs for Medicare beneficiaries in this area are: $24.96 for a new patient copayment and $28.8 for an established patient copayment.



Primary Taxonomy

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.

Taxonomy Code207Q00000X
ClassificationFamily Medicine
TypeAllopathic & Osteopathic Physicians
License No.MD00025990
License StateWA
Taxonomy DescriptionFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Accepted Insurance

The NPI profile data indicates this provider might be enrolled and accepting insurance plans from the following companies or healthcare programs:

  • Medicaid
  • Medicare

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Business Address

ANTONIO PEDROZA MD
3915 TALBOT RD S
STE 401
RENTON, WA
ZIP 98055
Phone: (425) 656-4224

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Mailing Address

ANTONIO PEDROZA MD
3600 LIND AVE SW
STE 100
RENTON, WA
ZIP 98055
Phone: (425) 656-5412


Location Map

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 ID5698706596
PECOS Enrollment IDI20050830000446
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 ImagingYes
Eligible order / refer Durable Medical EquipmentYes
Eligible order / refer Home Health Agency (HHA)Yes
Eligible order / refer Power Mobility DevicesYes

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 98055 ZIP code area.

New Patients Office Visits Costs *
Most Utilized Procedure Code for new patients office visits: 99203
Minimum New Patient Pricing Maximum New Patient Pricing Typical New Patient Pricing
$65.5 $195.25 $99.84
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$16.37 $48.81 $24.96
Established Patients Office Visits Costs *
Most Utilized Procedure Code for established patients office visits: 99214
Minimum Established Patient Pricing Maximum Established Patient Pricing Typical Established Patient Pricing
$21.08 $160.18 $115.21
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$5.27 $40.04 $28.8

* 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.

Overall MIPS Quality Performance

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

MIPS Measure Score Weight Score
Quality 40% 100
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 (PI) 25% 84
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 15% 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 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 20% 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 Final Score - 95.2
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.

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineMD00025990WANo

Taxonomy Description: a family medicine physician who specializes in the diagnosis and treatment of addictions.

Additional Identifiers


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
E33386MEDICARE UPIN (02)WA
E33386MEDICARE UPIN (02)

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.
1063426344
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
20123821238
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 0 + 1 + 2 + 3 + 8 + 2 + 1 + 2 + 3 + 8 + 24 = 56
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 56 = 44

The NPI number 1063426344 is valid because the calculated check digit 4 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1588663173 HOWARD NICHOLAS STRAUB DO
Individual
Ophthalmology3915 TALBOT RD S STE 310
RENTON, WA 98055
(425) 656-5345
1356398002PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY
Organization
Ophthalmology3915 TALBOT RD S SUITE 209
RENTON, WA 98055
(425) 656-5345
1831136985DR. DAVID GREGG VOSSLER MD
Individual
Psychiatry & Neurology (Neurology)3915 TALBOT RD S STE 104
RENTON, WA 98055
(425) 656-5566
1457392052PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY
Organization
Family Medicine (Adult Medicine)3915 TALBOT RD S SUITE 401
RENTON, WA 98055
(425) 656-4224
1003857665PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY
Organization
Neuromusculoskeletal Medicine & OMM3915 TALBOT RD S STE 104
RENTON, WA 98055
(425) 656-4566
1821039488PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY
Organization
Neurological Surgery3915 TALBOT RD S SUITE 216
RENTON, WA 98055
(425) 656-5595
1306882600DR. LARRY LEON BEACH O.D.
Individual
Optometrist (Corneal and Contact Management)3915 TALBOT RD S SUITE 209
RENTON, WA 98055
(425) 235-9911
1033147756 JOHN L. BONDI MD
Individual
Family Medicine (Adult Medicine)3915 TALBOT RD S STE 401
RENTON, WA 98055
(425) 656-4224
1548282353 JOHN A HERSMAN MD
Individual
Internal Medicine (Hematology & Oncology)3915 TALBOT RD S SUITE 300
RENTON, WA 98055
(425) 656-5570
1528080330 JONATHAN C BRITELL MD
Individual
Internal Medicine (Hematology & Oncology)3915 TALBOT RD S SUITE 300
RENTON, WA 98055
(425) 656-5570
1730193012 DORIS ROSELLINI MD
Individual
Family Medicine3915 TALBOT RD S STE 401
RENTON, WA 98055
(425) 656-4224
1194731208 GERALD ROSELLINI MD
Individual
Family Medicine3915 TALBOT RD S STE 401
RENTON, WA 98055
(425) 656-4224
1922014703 YAHUA YU MD
Individual
Psychiatry & Neurology (Neurology)3915 TALBOT RD S STE 104
RENTON, WA 98055
(425) 656-5566
1083725865MRS. CYNAMON QUINTON RD, CD
Individual
Dietitian, Registered3915 TALBOT RD S SUITE 200
RENTON, WA 98055
(253) 350-4477
1215039797 JULIE A MEYERS M.S, R.D., C.D.
Individual
Dietitian, Registered3915 TALBOT RD S SUITE 200
RENTON, WA 98055
(425) 656-4266
1952462087DANIEL MELBER, M.D. P.S.
Organization
Neuromusculoskeletal Medicine & OMM3915 TALBOT RD S SUITE 316
RENTON, WA 98055
(425) 235-4560
1912054859 JENNIFER L HOOCK MD
Individual
Family Medicine3915 TALBOT RD S STE 401
RENTON, WA 98055
(425) 656-4224
1982757522PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY
Organization
Psychiatry & Neurology (Neurology)3915 TALBOT RD S STE 104
RENTON, WA 98055
(425) 656-5566
1477756369DR. DEBBIE BEECHER PHARMD
Individual
Pharmacist (Pharmacotherapy)3915 TALBOT RD S SUITE 401
RENTON, WA 98055
(425) 228-3440
1134382427 TARA J MILLIRON MD
Individual
Family Medicine3915 TALBOT RD S STE 401
RENTON, WA 98055
(425) 656-4224

Frequently Asked Questions

What is Antonio Pedroza MD NPI number?

The NPI number assigned to Antonio Pedroza MD is 1063426344, registered as an "individual" on July 29, 2006

Where is Antonio Pedroza MD located?

The provider is located at 3915 Talbot Rd S Ste 401 Renton, Wa 98055 and the phone number is (425) 656-4224

Which is Antonio Pedroza MD specialty?

The provider's speciality is Family Medicine

How many years of experience does Antonio Pedroza MD have?

The provider has more than 43 years of experience. He graduated from University Of Nevada School Of Medicine in 1980.

What insurance does Antonio Pedroza MD 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 Antonio Pedroza MD registered in PECOS?

Yes, as of January 10, 2023 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), a Home Health Agency (HHA) and Power Mobility Devices.

What are Antonio Pedroza MD Quality Ratings?

The provider has an overall high rating in the following quality measures: quality clinical practices and patient outcomes and experiences , uses technology to exchange and make use of healthcare information.

How much is a visit to Antonio Pedroza MD?

Medicare beneficiaries should expect a typical cost of $99.84 with an average copayment of $24.96 for new patient appointments. Established patients should expect a typical charge of $115.21 and an average copayment of 28.8. Please review your insurance plan or contact the provider directly to determine your specific costs.

How do I update my NPI information?

The NPI record of Antonio Pedroza MD was last updated on July 29, 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]