DR. DAVID E SOWA M.D.
NPI 1104813377
Obstetrics & Gynecology in Plainville, CT
NPI Status: Active since October 04, 2005
Contact Information
184 EAST ST
GROVE HILL MEDICAL CENTER
PLAINVILLE, CT
ZIP 06062
Phone: (860) 747-0730
Fax: (860) 747-2028
- Individual
- Male
- Years of Experience 41
- Obstetrics & Gynecology
- Accepts Medicare Approved Payment
- PECOS Enrolled
- Medicare Quality Reporting
About DAVID SOWA
This page provides the complete NPI Profile along with additional information for David Sowa, a women's health care provider established in Plainville, Connecticut with a medical specialization in Obstetrics & Gynecology and more than 41 years of experience. He graduated from University Of Louisville School Of Medicine in 1985. The healthcare provider is registered in the NPI registry with number 1104813377 assigned on October 2005. The practitioner's primary taxonomy code is 207V00000X with license number 029591 (CT). The provider is registered as an individual and his NPI record was last updated 19 years ago.
- NPI
- 1104813377
- Provider Name
- DR. DAVID E SOWA M.D.
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 184 EAST ST GROVE HILL MEDICAL CENTER PLAINVILLE, CT 06062
- Location Phone
- (860) 747-0730
- Location Fax
- (860) 747-2028
- Mailing Address
- 300 KENSINGTON AVE GROVE HILL MEDICAL CENTER NEW BRITAIN, CT 06051
- Mailing Phone
- (860) 747-0730
- Mailing Fax
- (860) 747-2028
- Medical School Name
- UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE
- Graduation Year
- 1985
- Is Sole Proprietor?
- No
- Enumeration Date
- 10-04-2005
- Last Update Date
- 07-09-2007
- Code Navigator
Women's health care providers like David Sowa treat and diagnose diseases and conditions that affect a woman's physical and emotional health. Women's health professionals come from a variety of different specialties, including obstetrician/gynecologists, general surgeons, perinatologists, physician assistants, nurse practitioners or nurse midwives. A women's health provider might help you with family planning, breast care, pregnancy and child birth, osteoporosis, menopause, heart disease, 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
Obstetrics & Gynecology
- Taxonomy Code
- 207V00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 029591
- License State
- CT
- Taxonomy Description
- An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| P369836 | OTHER (01) | CT | OXFORD |
| 160000710 | MEDICARE ID-TYPE UNSPECIFIED (04) | CT | |
| 01029591 | OTHER (01) | CT | CIGNA |
| 1255448144 | OTHER (01) | CT | GHMC GROUP NPI ID |
| 2959101 | OTHER (01) | CT | CONNECTICARE |
| 004196095 | MEDICAID (05) | CT | |
| 010029591CT01 | OTHER (01) | CT | BCBS & BCFP ID |
| C01373 | MEDICARE ID-TYPE UNSPECIFIED (04) | CT | GHMC GROUP MEDICARE ID |
| 160031240 | OTHER (01) | CT | RAIL ROAD MEDICARE |
| 482005 | OTHER (01) | CT | AETNA |
| 368793 | OTHER (01) | CT | WELLCARE MEDICARE |
| 001295915 | MEDICAID (05) | CT | |
| 060027 | OTHER (01) | CT | HEALTH NET |
| D85312 | MEDICARE UPIN (02) |
Medicare Participation & PECOS Enrollment Status
David Sowa 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.
David Sowa 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: 446399315
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: I20091207000156
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.
Cervical or vaginal cancer screening; pelvic and clinical breast examination
Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory
This procedure involves checking for health issues in the lower abdomen and chest area. It helps identify early signs of certain conditions, increasing the chance for successful treatment. It's a routine check-up that's important for maintaining good health.
This service was performed 53 times for 53 patientsA Papanicolaou smear, often called a Pap smear, is a test to check for changes in cells. A small sample is gently collected from the lower region and sent to a lab for examination. This helps in early detection of potential health issues.
This service was performed 23 times for 23 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $34.71 for a new patient copayment and $18.88 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 06062 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $138.84
- Minimum New Patient Price $60.82
- Maximum New Patient Price $183.1
- Average New Patient Copayment $34.71
- Minimum New Patient Copayment $15.2
- Maximum New Patient Copayment $45.77
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $75.55
- Minimum Established Patient Price $19.76
- Maximum Established Patient Price $149.26
- Average Established Patient Copayment $18.88
- Minimum Established Patient Copayment $4.94
- Maximum Established Patient Copayment $37.31
* 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 |
|---|---|---|
| e-Prescribing | 95% | 2024 |
| 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 | 71% | 127 |
| 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. | ||
| Medication Reconciliation | 75% | 72 |
| 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. | ||
| Participation in CAHPS or other supplemental questionnaire | Yes | N/A |
| Participation in the Consumer Assessment of Healthcare Providers and Systems Survey or other supplemental questionnaire items (e.g., Cultural Competence or Health Information Technology supplemental item sets). | ||
| Patient-Specific Education | 6% | 1695 |
| 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. | ||
| Provide Patient Access | 25% | 1695 |
| 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. | ||
| Secure Messaging | 2% | 1695 |
| 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. | ||
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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 1104813377, we treat the final digit (7) 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 53. The final step is to find the difference between that total and the next multiple of ten (60 - 53 = 7).
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.
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.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 53 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 8 providers are registered at the same or a nearby location.
PLAINVILLE, CT 06062
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1104813377, enumerated as an "individual" on October 04, 2005.
The provider is located at 184 EAST ST GROVE HILL MEDICAL CENTER PLAINVILLE, CT 06062 and the phone number is (860) 747-0730.
Obstetrics & Gynecology with taxonomy code 207V00000X.
The provider might be accepting Accepts: Oxford Health Plans, Medicare, Medicaid, Cigna,. Please consult your insurance carrier or call the provider to verify.
