DR. JAMES P GUZEK MD
NPI 1104878859
Ophthalmology in Kennewick, WA

NPI Status: Active since May 17, 2006

Contact Information

6695 W RIO GRANDE AVE
KENNEWICK, WA
ZIP 99336
Phone: (509) 736-0826
Fax: (509) 735-6868

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

Individual
Male
Years of Experience 48
Ophthalmology
Accepts Insurance
Accepts Medicare Approved Payment
PECOS Enrolled

About JAMES GUZEK

This page provides the complete NPI Profile along with additional information for James Guzek, a provider established in Kennewick, Washington with a medical specialization in Ophthalmology and more than 48 years of experience. He graduated from Hahnemann University College Of Medicine in 1978. The healthcare provider is registered in the NPI registry with number 1104878859 assigned on May 2006. The practitioner's primary taxonomy code is 207W00000X with license number MD00040667 (WA). The provider is registered as an individual and his NPI record was last updated 5 years ago.

NPI: 1104878859
Provider Name: DR. JAMES P GUZEK MD
Gender: Male
Entity Type: Individual
Location Address: 6695 W RIO GRANDE AVE KENNEWICK, WA 99336
Location Phone: (509) 736-0826
Location Fax: (509) 735-6868
Mailing Address: PO BOX 1506 CHEHALIS, WA 98532
Mailing Phone: (360) 242-3008
Mailing Fax: (509) 735-6868
Medical School Name: HAHNEMANN UNIVERSITY COLLEGE OF MEDICINE
Graduation Year: 1978
Is Sole Proprietor?: No
Enumeration Date: 05-17-2006
Last Update Date: 11-23-2020
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Ophthalmologists like James Guzek specialize in diagnosing and treating eye conditions. They may perform surgeries to correct vision issues or prevent vision loss due to diseases like glaucoma. Additionally, they can provide eyeglasses, prescribe contact lenses, and offer other vision-related services.

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: Ophthalmology
Taxonomy Code: 207W00000X
Type: Allopathic & Osteopathic Physicians
License No.: MD00040667
License State: WA
Taxonomy Description: An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.

Insurance Plans Accepted

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

Blue Cross and Blue Shield of Montana

Blue Preferred Bronze PPO? 201 - PPO
Blue Preferred Bronze PPO? 202 - PPO
Blue Preferred Bronze PPO? Standard - PPO
Blue Preferred Gold PPO? 204 - PPO
Blue Preferred Gold PPO? 901 - PPO
Blue Preferred Gold PPO? Standard - PPO
Blue Preferred Security PPO? 200 - PPO
Blue Preferred Silver PPO? 203 - PPO
Blue Preferred Silver PPO? 308 - PPO
Blue Preferred Silver PPO? Standard - PPO

BridgeSpan Health Company

BridgeSpan Standard Bronze Plan - EPO
BridgeSpan Standard Gold Plan - EPO
BridgeSpan Standard Silver Plan - EPO

Kaiser Permanente

KP OR Bronze 6000 - EPO
KP OR Bronze HSA 7100 - EPO
KP OR Gold 0 - EPO
KP OR Gold 1750 - EPO
KP OR Silver 3000 - EPO
KP OR Silver 4000 - EPO
KP Oregon Standard Bronze Plan - EPO
KP Oregon Standard Gold Plan - EPO
KP Oregon Standard Silver Plan - EPO
KP OR Family Dental - $100 Ded - EPO
KP OR Family Dental - $1000 - EPO
KP OR Family Dental - $1000/$50 Ded - EPO

Moda Health Plan, Inc.

Moda Health Affinity Bronze 7750 - EPO
Moda Health Affinity Bronze 9000 - EPO
Moda Health Affinity Bronze HDHP 7500 - EPO
Moda Health Affinity Gold 1000 - EPO
Moda Health Affinity Gold 1500 - EPO
Moda Health Affinity Gold 250 - EPO
Moda Health Affinity Silver 3000 - EPO
Moda Health Affinity Silver 3400 - EPO
Moda Health Affinity Silver 4500 - EPO
Moda Health Affinity Silver 6000 - EPO
Moda Health Oregon Standard Bronze Affinity - EPO
Moda Health Oregon Standard Gold Affinity - EPO
Moda Health Oregon Standard Silver Affinity - EPO
Moda Select Bronze 8700 ($0 Virtual Urgent Care through CirrusMD) - EPO
Moda Select Bronze HDHP 7500 - EPO
Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - EPO
Moda Select Gold 1800 ($0 Virtual Urgent Care through CirrusMD) - EPO
Moda Select Silver 3500 ($0 Virtual Urgent Care through CirrusMD) - EPO
Moda Select Silver 4800 ($0 Virtual Urgent Care through CirrusMD) - EPO
Moda Select Silver 6400 ($0 Virtual Urgent Care through CirrusMD) - EPO

Mountain Health CO-OP

Connect Bronze Expanded Standard - PPO
Connect Bronze HDHP - PPO
Connect Catastrophic - PPO
Connect Gold - PPO
Connect Gold Standard - PPO
Connect Silver - PPO
Connect Silver Standard - PPO
High Plains Bronze HDHP - PPO
High Plains Bronze Standard Expanded - PPO
High Plains Gold - PPO
High Plains Gold HDHP - PPO
High Plains Gold Standard - PPO
High Plains Silver - PPO
High Plains Silver Standard - PPO
Plus Bronze Expanded - PPO
Plus Bronze Standard Expanded - PPO
Plus Gold - PPO
Plus Gold Standard - PPO
Plus Silver Standard - PPO
ACCESS BRONZE - PPO

PacificSource Health Plans

Navigator Bronze 7000 Exchange - PPO
Navigator Bronze 9200 - PPO
Navigator Bronze HSA 8050 - PPO
Navigator Gold 1500 - PPO
Navigator Gold 1500 Exchange - PPO
Navigator Gold 500 Exchange - PPO
Navigator Silver 3500 Exchange - PPO
Navigator Silver 4000 Exchange - PPO
Navigator Silver 5000 - PPO
Navigator Silver HSA 3500 - PPO
Navigator Standard Expanded Bronze - PPO
Navigator Standard Gold - PPO
Navigator Standard Silver - PPO
PacificSource Oregon Standard Bronze Plan NAV - PPO
PacificSource Oregon Standard Gold Plan NAV - PPO
PacificSource Oregon Standard Silver Plan NAV - PPO

Premera Blue Cross Blue Shield of Alaska

Premera Blue Cross Alaska One Gold - PPO
Premera Blue Cross Preferred Bronze 5800 HSA - PPO
Premera Blue Cross Preferred Bronze 6350 - PPO
Premera Blue Cross Preferred Gold 1500 - PPO
Premera Blue Cross Preferred Silver 4500 - PPO
Premera Blue Cross Standard Bronze II - PPO
Premera Blue Cross Standard Gold - PPO
Premera Blue Cross Standard Silver - PPO

Regence BlueCross BlueShield of Oregon

Bronze Essential 8500 With 4 Copay No Deductible Office Visits Individual and Family Network - EPO
Bronze HSA 7000 Individual and Family Network - EPO
Gold 2300 Individual and Family Network - EPO
Regence Standard Bronze Plan Individual and Family Network - EPO
Regence Standard Gold Plan Individual and Family Network - EPO
Regence Standard Silver Plan Individual and Family Network - EPO
Silver 6200 Individual and Family Network - EPO

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

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
1002514	MEDICAID (05)	WA
180043816	OTHER (01)	WA	RAIL ROAD MEDICARE
0048152	MEDICAID (05)	MT
8062921	MEDICAID (05)	ID
0157781	OTHER (01)	WA	L & I
3870GU	OTHER (01)	WA	REGENCE-KENNEWICK
M000082437	OTHER (01)	MT	MEDICARE MT

Medicare Participation & PECOS Enrollment Status

James Guzek 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.

James Guzek 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: 4486665825
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: I20060522000010, I20100202000321, I20100211000378
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.

Cataract surgery
Complex removal of cataract with insertion of prosthetic lens
Extracapsular removal of cataract with insertion of artificial lens and insertion of drainage device in front chamber of eye
Measurement of corneal curvature and depth of eye
Removal of cataract with insertion of prosthetic lens
Removal of recurring cataract in lens capsule using a laser
Removal or relocation of corneal conjunctiva with graft
Ultrasound scan to determine eye length and lens power

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $32.74 for a new patient copayment and $17.82 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 99336 ZIP code area.

New Patients Visit Costs *

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

Average New Patient Price $130.99
Minimum New Patient Price $57.27
Maximum New Patient Price $172.8

Average New Patient Copayment $32.74
Minimum New Patient Copayment $14.31
Maximum New Patient Copayment $43.2

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

Average Established Patient Price $71.29
Minimum Established Patient Price $18.56
Maximum Established Patient Price $141.11

Average Established Patient Copayment $17.82
Minimum Established Patient Copayment $4.64
Maximum Established Patient Copayment $35.27

* 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.

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.
1	1	0	4	8	7	8	8	5	9
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	1	0	4	16	7	16	8	10
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 1 + 0 + 4 + 1 + 6 + 7 + 1 + 6 + 8 + 1 + 0 + 24 = 61
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 61 = 9									9

The NPI number 1104878859 is valid because the calculated check digit 9 using the Luhn validation algorithm matches the last digit of the original NPI number.