DR. JAMES P SUTTON M.D. NPI 1114047628

Psychiatry & Neurology (Neurology) in Oxnard, CA

NPI 1114047628 Individual Male Psychiatry & Neurology Neurology PECOS Enrolled MIPS Quality Score 74 Medicare Quality Reporting

About JAMES SUTTON

James Sutton is a provider established in Oxnard, California and his medical specialization is psychiatry & neurology (neurology) . The NPI number of James Sutton is 1114047628 and was assigned on March 2007. The practitioner's primary taxonomy code is 2084N0400X with license number G060203 (CA). The provider is registered as an individual and his NPI record was last updated 15 years ago.

James Sutton is enrolled in PECOS and is eligible to order or refer healthcare 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.

James Sutton is a non-participating provider of Medicare. If you are a Medicare beneficiary this means the provider can charge up to 15% more than Medicare's approved amount for the cost of rendered services, in addition to your normal deductible and coinsurance costs. There are some states that restrict the limiting charge when you see non-participating provider. If you pay the full cost of your care up front, your non- participating provider should still submit a claim to Medicare. Afterward, you should receive reimbursement from Medicare for up 80% of the Medicare-approved amount for the services rendered.

The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 74, 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 provider also has detailed performance information the following quality measures: collection and use of patient experience and satisfaction data on access, dementia associated behavioral and psychiatric symptoms screening and management, dementia: functional status assessment, documentation of current medications in the medical record, engagement of patients through implementation of improvements in patient portal, overuse of imaging for the evaluation of primary headache, parkinson's disease: cognitive impairment or dysfunction assessment for patients with parkinson's disease, parkinson's disease: psychiatric symptoms assessment for patients with parkinson's disease and security risk analysis.

NPI

1114047628

Provider NameDR. JAMES P SUTTON M.D.
Provider Location Address1701 SOLAR DR SUITE 140 OXNARD, CA 93030
Provider Mailing Address1701 SOLAR DR SUITE 140 OXNARD, CA 93030
GenderMale
NPI Entity TypeIndividual
Is Sole Proprietor?No
Is Organization Subpart?N/A
Enumeration Date03-29-2007
Last Update Date07-08-2007


Primary Taxonomy

Taxonomy Code2084N0400X
ClassificationPsychiatry & Neurology
TypeAllopathic & Osteopathic Physicians
SpecializationNeurology
License No.G060203
License StateCA
Taxonomy DescriptionA Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.

Business Address

DR. JAMES P SUTTON M.D.
1701 SOLAR DR
SUITE 140
OXNARD, CA
ZIP 93030
Phone: (805) 278-4148
Fax: (805) 278-4634

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Mailing Address

DR. JAMES P SUTTON M.D.
1701 SOLAR DR
SUITE 140
OXNARD, CA
ZIP 93030
Phone: (805) 278-4148
Fax: (805) 278-4634



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
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% 95.4
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% 0
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 - 74
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.

MIPS Quality Measures

The following performance measures were reported under the Merit-Based Incentive Payment System (MIPS) and Qualified Clinical Data Registry (QCDR) quality measures program.

Quality Measure Performance Number of Patients
Collection and use of patient experience and satisfaction data on accessYesN/A
Collection of patient experience and satisfaction data on access to care and development of an improvement plan, such as outlining steps for improving communications with patients to help understanding of urgent access needs.
Dementia Associated Behavioral and Psychiatric Symptoms Screening and Management 100% 218
Percentage of patients with dementia for whom there was a documented screening for behavioral and psychiatric symptoms, including depression, and for whom, if symptoms screening was positive, there was also documentation of recommendations for management in the last 12 months
Dementia: Functional Status Assessment 100% 221
Percentage of patients with dementia for whom an assessment of functional status was performed at least once in the last 12 months
Documentation of Current Medications in the Medical Record 99% 1451
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
Engagement of patients through implementation of improvements in patient portalYesN/A
Access to an enhanced patient portal that provides up to date information related to relevant chronic disease health or blood pressure control, and includes interactive features allowing patients to enter health information and/or enables bidirectional communication about medication changes and adherence.
Overuse of Imaging for the Evaluation of Primary Headache 0% "Inverse Quality Measure"
This is an inverse quality measure, a lower rate means the provider is rated better.
57
Percentage of patients for whom imaging of the head (CT or MRI) is obtained for the evaluation of primary headache when clinical indications are not present
Parkinson's Disease: Cognitive Impairment or Dysfunction Assessment for Patients with Parkinson's Disease 100% 229
Percentage of all patients with a diagnosis of Parkinson's Disease [PD] who were assessed for cognitive impairment or dysfunction in the past 12 months
Parkinson's Disease: Psychiatric Symptoms Assessment for Patients with Parkinson's Disease 95% 251
Percentage of all patients with a diagnosis of Parkinson's Disease [PD] who were assessed for psychiatric symptoms in the past 12 months
Security Risk AnalysisYesN/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 electronic health record technology (CEHRT) in accordance with requirements in 45 CFR 164.312(a)(2)(iv) and 164.306(d)(3), implement security updates as necessary, and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.

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.

  • 670Neuropsychological testing, interpretation, and report by psychologist or physician per hour (HCPCS:96118)
  • 63Measurement and recording of brain wave (EEG) activity, awake and asleep (HCPCS:95819)
  • 44Measurement and recording of brain wave (EEG) activity, awake and drowsy (HCPCS:95816)

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
F02751MEDICARE UPIN (02)CA

Other Providers at the same location


The following 10 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1326039322MR. LARRY PATRICK BROWN PT
Individual
Physical Therapist1701 SOLAR DR SUITE 155
OXNARD, CA 93030
(805) 604-4644
1598708190DR. MARWOOD M STOUT DDS
Individual
Dentist (Oral and Maxillofacial Surgery)1701 SOLAR DR SUITE 291
OXNARD, CA 93030
(805) 981-8144
1255421707DR. BRYAN RYO FUJII DDS
Individual
Dentist1701 SOLAR DR SUITE 270
OXNARD, CA 93030
(805) 983-3552
1871710814LARRY BROWN D/B/A COAST PHYSICAL THERAPY SPEC
Organization
Specialist1701 SOLAR DR STE. 155
OXNARD, CA 93030
(805) 604-4644
1003033846MRS. TESSA WAGGONER PT
Individual
Specialist1701 SOLAR DR STE. 155
OXNARD, CA 93030
(805) 604-4644
1255668570 RAY JASON FAJARDO MS, PA-C
Individual
Physician Assistant1701 SOLAR DR SUITE 140
OXNARD, CA 93030
(805) 278-4148
1144340662ENCEPHALOGIC MEDICAL GROUP, INC.
Organization
Psychiatry & Neurology (Neurology)1701 SOLAR DR SUITE 140
OXNARD, CA 93030
(805) 278-4148
1619302767CAWTHON DDS INC.
Organization
Dentist (Orthodontics and Dentofacial Orthopedics)1701 SOLAR DR SUITE 290
OXNARD, CA 93030
(805) 479-8706
1235255258 DAVID G MUSGROVE P.T.
Individual
Physical Therapist1701 SOLAR DR STE 155
OXNARD, CA 93030
(805) 654-8127
1972667178DR. PAUL MARTIN PH.D.
Individual
Clinical Neuropsychologist1701 SOLAR DR SUITE 261
OXNARD, CA 93030
(805) 660-0507

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
The code describing 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.