MR. FRANK J TOOLE III PA NPI 1093777302

Physician Assistant - Medical in Westerly, RI

Individual Male Years of Experience 30 Physician Assistant Medical PECOS Enrolled Accepts Medicare Approved Payment MIPS Quality Score 96.4

About MR. FRANK J TOOLE III PA

Frank Toole is a primary care provider established in Westerly, Rhode Island and his medical specialization is Physician Assistant with a focus in medical with more than 30 years of experience. He graduated from Yale University School Of Medicine in 1993. The NPI number of Frank Toole is 1093777302 and was assigned on April 2006. The practitioner's primary taxonomy code is 363AM0700X with license number PA00242 (RI). The provider is registered as an individual and his NPI record was last updated 7 years ago.

A primary care provider (PCP) like Mr. Frank J Toole Iii Pa 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

NPI

1093777302

Provider NameMR. FRANK J TOOLE III PA
Provider Location Address81 BEACH ST WESTERLY, RI 02891
Provider Mailing Address81 BEACH ST WESTERLY, RI 02891
GenderMale
NPI Entity TypeIndividual
Medical School NameYALE UNIVERSITY SCHOOL OF MEDICINE
Graduation Year1993
Is Sole Proprietor?No
Enumeration Date04-03-2006
Last Update Date03-25-2015



Frank Toole 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.

Frank Toole 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 Lawrence & Memorial Hospital.

The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 96.4, 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.



Primary Taxonomy

Taxonomy Code363AM0700X
ClassificationPhysician Assistant
TypePhysician Assistants & Advanced Practice Nursing Providers
SpecializationMedical
License No.PA00242
License StateRI

Business Address

MR. FRANK J TOOLE III PA
81 BEACH ST
WESTERLY, RI
ZIP 02891
Phone: (401) 596-9039
Fax: (401) 596-8750

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Mailing Address

MR. FRANK J TOOLE III PA
81 BEACH ST
WESTERLY, RI
ZIP 02891
Phone: (401) 596-9039
Fax: (401) 596-8750


PECOS Enrollment and Medicare Participation

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 ID4789753849
PECOS Enrollment IDI20171103001518
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

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% 74.7
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 - 96.4
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.

Clinician Utilization

The following Healthcare Common Procedure Coding System (HCPCS) codes were publicly reported as the top services rendered by this provider under the Medicare program for the year 2017. The reported codes are based on the top 5 codes for each available Medicare specialty, excluding evaluation and management codes.

  • 64Aspiration and/or injection of large joint or joint capsule (HCPCS:20610)
  • 20Injection, methylprednisolone acetate, 40 mg (HCPCS:J1030)
  • 16Repair of knee joint (HCPCS:27447)

Hospital Affiliations

Medicare hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the Medicare 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. Frank Toole is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
LAWRENCE & MEMORIAL HOSPITAL365 MONTAUK AVE
NEW LONDON, CT 6320
(860) 442-0711Acute Care Hospitals70007

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 Identifier Issuer
209082059MEDICARE PIN (08)RI
979006084OTHER (01)MEDICARE PA PTAN
N170172MEDICAID (05)RI

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.
1093777302
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
201831471430
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 0 + 1 + 8 + 3 + 1 + 4 + 7 + 1 + 4 + 3 + 0 + 24 = 58
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 58 = 22

The NPI number 1093777302 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the same location


The following 8 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1003005497NINIGRET ORTHOPEDICS INC
Organization
Orthopaedic Surgery81 BEACH ST
WESTERLY, RI 02891
(401) 596-9039
1750519773ATLANTIC ORTHOPEDICS LLC
Organization
Clinic/Center (Medical Specialty)81 BEACH ST
WESTERLY, RI 02891
(401) 315-5595
1518268697JOSEPH P. GIANCASPRO, M.D., LTD
Organization
Family Medicine81 BEACH ST
WESTERLY, RI 02891
(401) 596-2230
1205830700 ANNE M. GARVEY M.D.
Individual
Pediatrics81 BEACH ST
WESTERLY, RI 02891
(401) 596-3229
1013456920DR. BRIDGET GAMACHE DPT
Individual
Physical Therapist81 BEACH ST
WESTERLY, RI 02891
(401) 596-3593
1982218749 LOIS RICE
Individual
Physical Therapist81 BEACH ST
WESTERLY, RI 02891
(401) 596-3593
1679189427 ELEANOR DEREDITA DPT
Individual
Physical Therapist81 BEACH ST
WESTERLY, RI 02891
(401) 596-3593
1679168355MASONICARE HOME HEALTH AND HOSPICE, INC.
Organization
Hospice Care, Community Based81 BEACH ST
WESTERLY, RI 02891
(888) 332-0033

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
Mr. Frank J Toole Iii Pa is registered as an entity type code: 1. The entity type code describes the type of health care provider that is being assigned an NPI. The entity type codes are:

  • 1 = Person: individual human being who furnishes health care.
  • 2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
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.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.