DR. JESS GRAHAM M.D.
NPI 1083604854
Radiology - Diagnostic Radiology in Albuquerque, NM

Medicare Participation & PECOS Enrollment Status

Jess Graham 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.

Jess Graham 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: 9436160314

  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: I20191029001153, I20221130000547

  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

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.

Ct scan of abdomen and pelvis with contrast

A CT scan of the abdomen and pelvis with contrast is an imaging procedure. A special dye, called contrast, is used to make certain areas more visible. This can help identify issues such as infections, tumors, or other abnormalities. The procedure is painless and usually takes about 30 minutes.

This service was performed 27 times for 27 patients

Ct scan of abdomen and pelvis without contrast

A CT scan of the abdomen and pelvis is a non-invasive medical test. It uses special X-ray equipment to create detailed images of your abdominal and pelvic areas. This helps doctors examine organs, tissues, and vessels. No contrast dye is used in this procedure.

This service was performed 23 times for 23 patients

Nuclear medicine studies of kidney, blood flow, and function

Nuclear medicine studies of the kidney, blood flow, and function involve using small amounts of radioactive materials to create images of your kidneys. This helps in assessing their structure and working condition, aiding in early diagnosis and treatment planning.

This service was performed 23 times for 23 patients

Nuclear medicine study from skull base to mid-thigh with ct scan

A nuclear medicine study from skull base to mid-thigh with a CT scan involves using a small amount of radioactive material and CT imaging to examine body tissues and organs. This helps detect any abnormalities by providing detailed images of the body's internal structure.

This service was performed 289 times for 286 patients

Nuclear medicine study from skull base to mid-thigh with ct scan

A nuclear medicine study from skull base to mid-thigh with a CT scan involves using a small amount of radioactive material and CT imaging to examine body tissues and organs. This helps detect any abnormalities by providing detailed images of the body's internal structure.

This service was performed 492 times for 469 patients

Nuclear medicine study of bone and/or joint whole body

A nuclear medicine study of bone and/or joint whole body involves injecting a small amount of radioactive material into your body. This material travels to your bones and emits energy. A special camera captures this energy, creating images of your bones to help identify any abnormalities.

This service was performed 339 times for 325 patients

Nuclear medicine study of bone taken at different times

A nuclear medicine bone study involves injecting a small amount of radioactive material into your body. This material collects in the bones and is detected by a special camera to create images. These images are taken at different times to track changes and help diagnose bone conditions.

This service was performed 69 times for 69 patients

Nuclear medicine study of brain, less than 4 static views

A nuclear medicine study of the brain involves using a safe, radioactive substance and special imaging techniques to visualize brain function. Less than 4 static views means only a few images are taken. This helps diagnose various brain disorders.

This service was performed 14 times for 14 patients

Nuclear medicine study of heart pumping function by labeling red blood cells with measurement of internal blood volume ejected with every beat over multiple cycles

This procedure, known as a nuclear medicine study, examines your heart's function. It involves marking red blood cells and measuring the volume of blood your heart pumps with each beat. It's a safe, non-invasive way to assess how well your heart is working.

This service was performed 18 times for 16 patients

Nuclear medicine study of kidney, blood, flow, and function with drug administration

This procedure helps analyze kidney function using a safe radioactive substance and special imaging. The substance is administered through an injection and travels to your kidneys. Images are then taken to assess blood flow and overall kidney function.

This service was performed 36 times for 34 patients

Nuclear medicine study of liver and bile duct system

A nuclear medicine study of the liver and bile duct system involves the use of a small amount of radioactive material to create detailed images. This helps doctors examine the liver's function and structure, and detect any abnormalities in the bile ducts.

This service was performed 104 times for 104 patients

Nuclear medicine study of liver and bile duct system with use of drugs

A nuclear medicine study of the liver and bile duct system involves injecting a safe, radioactive substance into the body. This substance helps create images of these areas on a special camera. It's often combined with drug use to improve image clarity and aid in diagnosing various conditions.

This service was performed 41 times for 41 patients

Nuclear medicine study of lung circulation

A nuclear medicine study of lung circulation involves the use of a safe, radioactive substance to visualize lung function. It helps in diagnosing conditions like blood clots. The substance is injected and images are taken to study the blood flow in your lungs.

This service was performed 30 times for 30 patients

Nuclear medicine study of lung ventilation and circulation

A nuclear medicine lung ventilation and circulation study uses a safe radioactive material to create images of air and blood flow in your lungs. It helps identify issues like blood clots or lung diseases. You inhale or receive an injection of this material, and a special camera captures the images.

This service was performed 167 times for 162 patients

Nuclear medicine study of lymphatic system

A nuclear medicine study of the lymphatic system involves injecting a safe, radioactive substance into your body. This substance travels through your lymphatic system and helps create images on a special camera. These images can help doctors diagnose conditions related to your immune system.

This service was performed 45 times for 45 patients

Nuclear medicine study of parathyroid with spect and ct scan

A nuclear medicine study of the parathyroid with SPECT and CT scan is a diagnostic procedure. It uses a safe radioactive substance and imaging techniques to create detailed pictures of your parathyroid glands. These images help identify any abnormalities or diseases.

This service was performed 14 times for 14 patients

Nuclear medicine study of stomach to assess emptying

A nuclear medicine study of the stomach assesses how quickly food leaves the stomach. A safe, radioactive substance is added to a meal. The radiation emitted is tracked, creating images that show the food's progress through the stomach. It's non-invasive and painless.

This service was performed 84 times for 82 patients

Nuclear medicine study of thyroid and thyroid function

A nuclear medicine study of the thyroid involves using a small amount of radioactive material to evaluate thyroid function. It helps identify issues such as overactive or underactive thyroid. The procedure is safe and provides valuable information about your thyroid health.

This service was performed 13 times for 13 patients

Nuclear medicine study to assess blood loss

A nuclear medicine study is a type of imaging test. It uses a small amount of radioactive material to help identify blood loss. This material is injected into your body and detected by a special camera, providing images of your internal structures.

This service was performed 28 times for 28 patients

Nuclear medicine study whole body with ct scan

A Nuclear Medicine Study with a CT Scan is a diagnostic procedure. It uses a small amount of radioactive substance and a CT scan to create detailed images of your body. These images help doctors diagnose, monitor, and treat various conditions.

This service was performed 35 times for 35 patients

Nuclear medicine study whole body with ct scan

A Nuclear Medicine Study with a CT Scan is a diagnostic procedure. It uses a small amount of radioactive substance and a CT scan to create detailed images of your body. These images help doctors diagnose, monitor, and treat various conditions.

This service was performed 55 times for 53 patients

Nuclear medicine study, 1 area with spect

A nuclear medicine study with SPECT involves a safe, small amount of radioactive substance to help visualize body organs. SPECT, or Single Photon Emission Computed Tomography, creates detailed 3D images. This helps doctors diagnose and monitor conditions in a specific body area.

This service was performed 33 times for 33 patients

X-ray of chest, 1 view

A chest X-ray, 1 view, is a quick, painless test that produces images of the structures within your chest, such as your heart, lungs, and blood vessels. It helps in diagnosing conditions like pneumonia, heart problems, or lung cancer. You'll stand in front of a machine that emits X-rays, which pass through your body to create the image.

This service was performed 15 times for 15 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $21.19 for a new patient copayment and $17 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 87106 ZIP code area.

* 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.

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 94.99, 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 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: 94.99 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: 78.84

  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: 98.09

  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.

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Jess Graham is affiliated with the following medical facilities:

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NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

The NPI number 1083604854 is valid because the calculated check digit 4 using the Luhn validation algorithm matches the last digit of the original NPI number.

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Frequently Asked Questions