STEPHEN B FORTSON MD
NPI 1073819058
Internal Medicine in Pell City, AL

NPI Status: Active since February 08, 2011

Contact Information

70 PLAZA DR
PELL CITY, AL
ZIP 35125
Phone: (205) 814-9284
Fax: (205) 814-9626

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Medicare Participation & PECOS Status
Areas of Expertise
Durable Medical Equipment
Physician Visit Costs
Quality Reporting
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Male
Years of Experience 16
Internal Medicine
Accepts Insurance
Accepts Medicare Approved Payment
PECOS Enrolled
Medicare Quality Reporting

About STEPHEN FORTSON

This page provides the complete NPI Profile along with additional information for Stephen Fortson, an internist established in Pell City, Alabama with a medical specialization in Internal Medicine and more than 16 years of experience. He graduated from Mercer University School Of Medicine in 2011. The healthcare provider is registered in the NPI registry with number 1073819058 assigned on February 2011. The practitioner's primary taxonomy code is 207R00000X with license number 33178 (AL). The provider is registered as an individual and his NPI record was last updated 11 years ago.

NPI: 1073819058
Provider Name: STEPHEN B FORTSON MD
Gender: Male
Entity Type: Individual
Location Address: 70 PLAZA DR PELL CITY, AL 35125
Location Phone: (205) 814-9284
Location Fax: (205) 814-9626
Mailing Address: 70 PLAZA DR PELL CITY, AL 35125
Mailing Phone: (205) 814-9284
Mailing Fax: (205) 814-9626
Medical School Name: MERCER UNIVERSITY SCHOOL OF MEDICINE
Graduation Year: 2011
Is Sole Proprietor?: No
Enumeration Date: 02-08-2011
Last Update Date: 10-28-2015
Code Navigator

An internist like Stephen Fortson is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, 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: Internal Medicine
Taxonomy Code: 207R00000X
Type: Allopathic & Osteopathic Physicians
License No.: 33178
License State: AL
Taxonomy Description: 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.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Ambetter from Magnolia Health

Choice Bronze HSA - HMO
Choice Bronze HSA + Vision + Adult Dental - HMO
Complete Gold - HMO
Complete Gold + Vision + Adult Dental - HMO
Everyday Bronze - HMO
Everyday Bronze + Vision + Adult Dental - HMO
Everyday Gold - HMO
Everyday Gold + Vision + Adult Dental - HMO
Standard Expanded Bronze - HMO
Standard Expanded Bronze + Vision + Adult Dental - HMO

Ambetter Health

Clarity Silver - HMO
Complete Gold - HMO
Complete Gold + Vision + Adult Dental - HMO
Elite Bronze - HMO
Elite Bronze + Vision + Adult Dental - HMO
Enhanced Diabetes Care Silver with $0 Drug Options - HMO
Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - HMO
Everyday Bronze - HMO
Everyday Bronze + Vision + Adult Dental - HMO
Everyday Gold - HMO

Ambetter of Alabama

Complete Gold - EPO
Complete Gold + Vision + Adult Dental - EPO
Elite Bronze - EPO
Elite Bronze + Vision + Adult Dental - EPO
Elite Gold - EPO
Elite Gold + Vision + Adult Dental - EPO
Enhanced Diabetes Care Silver with $0 Drug Options - EPO
Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
Everyday Bronze - EPO
Everyday Bronze + Vision + Adult Dental - EPO

Ambetter of Tennessee

Elite Bronze - EPO
Elite Bronze + Vision + Adult Dental - EPO
Elite Gold - EPO
Elite Gold + Vision + Adult Dental - EPO
Enhanced Diabetes Care Silver with $0 Drug Options - EPO
Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
Everyday Bronze - EPO
Everyday Bronze + Vision + Adult Dental - EPO
Everyday Gold - EPO
Everyday Gold + Vision + Adult Dental - EPO

Blue Cross and Blue Shield of Alabama

Blue Cross Select Gold - PPO
Blue Cross Select Silver - PPO
Blue HSA Bronze - PPO
Blue Protect - PPO
Blue Saver Bronze - PPO
Blue Saver Silver EPO - EPO
Blue Standardized Bronze - PPO
Blue Standardized Gold - PPO
Blue Standardized Silver - PPO
Blue Standardized Silver EPO - EPO

Oscar Insurance Company

Bronze Classic 4700 - EPO
Bronze Classic Standard - EPO
Bronze Elite + PCP Saver Plus - EPO
Bronze Simple Chronic Care CKM - EPO
Gold Classic Standard - EPO
Gold Simple - EPO
Silver Classic Standard - EPO
Silver Simple - EPO
Silver Simple Chronic Care CKM - EPO

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

Medicare Participation & PECOS Enrollment Status

Stephen Fortson 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.

Stephen Fortson 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: 8628298643
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: I20140925000894
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-Medical/Surgical Supplies (DA023N)
Collagen dressing, sterile, size 16 sq. in. or less, each (HCPCS:A6021)
2 DME suppliers used 11 Medicare Claims 212 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 15 Medicare Claims 15 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 51 Medicare Claims 51 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)
4 DME suppliers used 101 Medicare Claims 101 Services Paid
DME-Oxygen and Supplies (DC002N)
Portable oxygen concentrator, rental (HCPCS:E1392)
1 DME suppliers used 41 Medicare Claims 41 Services Paid
DME-Wheelchairs (DD000N)
Standard wheelchair (HCPCS:K0001)
2 DME suppliers used 84 Medicare Claims 84 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.

Administration of influenza virus vaccine
Annual alcohol misuse screening, 15 minutes
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
Automated urinalysis test
Blood test, basic group of blood chemicals (calcium, total)
Blood test, lipids (cholesterol and triglycerides)
Blood test, thyroid stimulating hormone (tsh)
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count
Cyanocobalamin (vitamin b-12) level
Dxa bone density measurement of hip, pelvis, spine including spine fracture assessment
Established patient office or other outpatient visit, 20-29 minutes
Established patient office or other outpatient visit, 30-39 minutes
Follow-up hospital inpatient care per day, typically 25 minutes
Follow-up hospital inpatient care per day, typically 35 minutes
Follow-up nursing facility visit per day, typically 10 minutes
Follow-up nursing facility visit per day, typically 15 minutes
Follow-up nursing facility visit per day, typically 25 minutes
Hemoglobin a1c level
Hospital discharge day management, 30 minutes or less
Hospital discharge day management, more than 30 minutes
Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage
Initial hospital inpatient care per day, typically 70 minutes
Initial hospital observation care per day, typically 70 minutes
Initial nursing facility visit per day, typically 35 minutes
Injection of drug or substance under skin or into muscle
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg
Insertion of needle into vein for collection of blood sample
Liver function blood test panel
Screening 3d breast mammography
Screening mammography
Thyroxine (thyroid chemical), free
Vitamin d-3 level

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $30.57 for a new patient copayment and $23.43 for an established patient copayment.

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 35125 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99204

Average New Patient Price $122.31
Minimum New Patient Price $52.65
Maximum New Patient Price $161.63

Average New Patient Copayment $30.57
Minimum New Patient Copayment $13.16
Maximum New Patient Copayment $40.4

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

Average Established Patient Price $93.72
Minimum Established Patient Price $16.56
Maximum Established Patient Price $131.65

Average Established Patient Copayment $23.43
Minimum Established Patient Copayment $4.14
Maximum Established Patient Copayment $32.91

* 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.

Quality Reporting

The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

Quality Measure	Performance	Number of Patients
Breast Cancer Screening	44%	593
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
Care Plan	88%	1240
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan
Chronic Care and Preventative Care Management for Empaneled Patients	Yes	N/A
Proactively manage chronic and preventive care for empaneled patients that could include one or more of the following: • Provide patients annually with an opportunity for development and/or adjustment of an individualized plan of care as appropriate to age and health status, including health risk appraisal; gender, age and condition-specific preventive care services; and plan of care for chronic conditions; • Use condition-specific pathways for care of chronic conditions (e.g., hypertension, diabetes, depression, asthma and heart failure) with evidence-based protocols to guide treatment to target; such as a CDC-recognized diabetes prevention program; • Use pre-visit planning to optimize preventive care and team management of patients with chronic conditions; • Use panel support tools (registry functionality) to identify services due; • Use predictive analytical models to predict risk, onset and progression of chronic diseases; or • Use reminders and outreach (e.g., phone calls, emails, postcards, patient portals and community health workers where available) to alert and educate patients about services due; and/or routine medication reconciliation.
Colorectal Cancer Screening	41%	1180
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
Diabetes: Eye Exam	28%	459
Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period
Diabetes: Foot Exam	27%	457
The percentage of patients 18-75 years of age with diabetes (type 1 and type 2) who received a foot exam (visual inspection and sensory exam with mono filament and a pulse exam) during the measurement year
Diabetes: Medical Attention for Nephropathy	95%	459
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
Documentation of Current Medications in the Medical Record	100%	5287
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration
e-Prescribing	98%	19357
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Health Information Exchange	76%	848
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for at least one transition of care or referral.
Implementation of medication management practice improvements	Yes	N/A
Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/or Conduct periodic, structured medication reviews.
Measurement and Improvement at the Practice and Panel Level	Yes	N/A
Measure and improve quality at the practice and panel level, such as the American Board of Orthopaedic Surgery (ABOS) Physician Scorecards, that could include one or more of the following: • Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice level and at the level of the care team or MIPS eligible clinician or group (panel); and/or • Use relevant data sources to create benchmarks and goals for performance at the practice level and panel level.
Medication Reconciliation	98%	353
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
Patient-Specific Education	80%	2548
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan	56%	2248
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2
Preventive Care and Screening: Influenza Immunization	20%	2237
Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization
Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling	65%	1379
Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 24 months AND who received brief counseling if identified as an unhealthy alcohol user
Provide Patient Access	80%	2548
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information.
Screening for Osteoporosis for Women Aged 65-85 Years of Age	57%	425
Percentage of female patients aged 65-85 years of age who ever had a central dual-energy X-ray absorptiometry (DXA) to check for osteoporosis
Secure Messaging	39%	2548
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period.
Security Risk Analysis	Yes	N/A
Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.
Specialized Registry Reporting	Yes	N/A
The MIPS eligible clinician is in active engagement to submit data to specialized registry. To earn a 5 % bonus in the promoting interoperability performance category score for submitting to one or more public health or clinical data registries also attest to PI_TRANS_PHCDRR_3_MULTI.
Use of decision support and standardized treatment protocols	Yes	N/A
Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs.
Use of High-Risk Medications in the Elderly	3% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better.	1016
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication. 2) Percentage of patients who were ordered at least two of the same high-risk medication

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 1073819058, we treat the final digit (8) 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 52. The final step is to find the difference between that total and the next multiple of ten (60 - 52 = 8).

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.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 14 → 1 + 4

Pos 4

Unchanged

Pos 5

Doubled → 16 → 1 + 6

Pos 6

Unchanged

Pos 7

Doubled → 18 → 1 + 8

Pos 8

Unchanged

Pos 9

Doubled → 10 → 1 + 0

Check

Target digit

Regular digit Doubled digit Check digit

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.

1 → 2 7 → 14 → 5 8 → 16 → 7 9 → 18 → 9 5 → 10 → 1

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 0 + 1 + 4 + 3 + 1 + 6 + 1 + 1 + 8 + 0 + 1 + 0 + 24 = 52

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 52 is 60. The difference is the calculated check digit.

60 - 52 = 8

This NPI is valid

The calculated check digit is 8, which matches the last digit of 1073819058.

Other Providers at the Same Location

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

DR. CARL T FROSINA MD

Internal Medicine

70 PLAZA DR, INRI MEDICAL ASSOCIATES PC DBA NORTHSIDE MEDICAL
PELL CITY, AL 35125

St. Clair County (205) 814-9284

DR. WILLIAM HARVEY MCCLANAHAN JR. MD

Internal Medicine

70 PLAZA DR, NORTHSIDE MEDICAL
PELL CITY, AL 35125

St. Clair County (205) 814-9284

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