MICHAEL PATRICK MACDONALD NP
NPI 1124597588
Nurse Practitioner - Primary Care in Plymouth, MA
NPI Status: Active since November 15, 2018
Contact Information
1 BUMPS POND ROAD
PLYMOUTH, MA
ZIP 02360
Phone: (508) 291-2441
- Individual
- Male
- Years of Experience 8
- Nurse Practitioner
- Primary Care
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
- Medicare Quality Reporting
About MICHAEL MACDONALD
This page provides the complete NPI Profile along with additional information for Michael Macdonald, a provider established in Plymouth, Massachusetts with a medical specialization in Nurse Practitioner, focusing in primary care and more than 8 years of experience. The healthcare provider is registered in the NPI registry with number 1124597588 assigned on November 2018. The practitioner's primary taxonomy code is 363LP2300X with license number RN2312494 (MA). The provider is registered as an individual and his NPI record was last updated 8 years ago.
- NPI
- 1124597588
- Provider Name
- MICHAEL PATRICK MACDONALD NP
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 1 BUMPS POND ROAD PLYMOUTH, MA 02360
- Location Phone
- (508) 291-2441
- Mailing Address
- 11 GIBBENS ST WEYMOUTH, MA 02188
- Mailing Phone
- (781) 858-5578
- Medical School Name
- OTHER
- Graduation Year
- 2018
- Is Sole Proprietor?
- No
- Enumeration Date
- 11-15-2018
- Last Update Date
- 11-15-2018
- Code Navigator
A nurse practitioner (NP) like Michael Macdonald is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, 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
Nurse Practitioner Primary Care
- Taxonomy Code
- 363LP2300X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- License No.
- RN2312494
- License State
- MA
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Anthem Bronze Access Blue New England HMO 6000/20%/8000 w/HSA - HMO
- Anthem Bronze Access Blue New England HMO 7000/50%/8000 w/HSA - HMO
- Anthem Bronze Access Blue New England HMO 7500/30%/10000 Value - HMO
- Anthem Bronze Access Blue New England HMO 8500/50%/9200 - HMO
- Anthem Gold Access Blue New England HMO 1000/20%/7500 - HMO
- Anthem Gold Access Blue New England HMO 2000/0%/6500 RxD - HMO
- Anthem Gold Access Blue New England HMO 2000/10%/4600 w/HSA - HMO
- Anthem Gold Access Blue New England HMO 2000/10%/7500 - HMO
- Anthem Gold Access Blue New England HMO 2000/20%/4600 w/HSA - HMO
- Anthem Gold Access Blue New England HMO 3000/0%/7500 RxD - HMO
- Anthem Gold Access Blue New England HMO 500/30%/9000 - HMO
- Anthem Platinum Access Blue New England HMO 250/10%/3500 - HMO
- Anthem Silver Access Blue New England HMO 2500/30%/10000 Value - HMO
- Anthem Silver Access Blue New England HMO 3000/30%/9000 Value - HMO
- Anthem Silver Access Blue New England HMO 3500/20%/10000 - HMO
- Anthem Silver Access Blue New England HMO 3500/20%/7250 w/HSA - HMO
- Anthem Silver Access Blue New England HMO 4000/0%/9000 - HMO
- Anthem Silver Access Blue New England HMO 4000/0%/9000 RxD - HMO
- Anthem Silver Access Blue New England HMO 4000/10%/7250 w/HSA - HMO
- Anthem Silver Access Blue New England HMO 4000/20%/8500 - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medicare Participation & PECOS Enrollment Status
Michael Macdonald 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.
Michael Macdonald 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: 4082047394
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: I20191127000340
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.
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms
Established patient office or other outpatient visit, 30-39 minutes
Testing for presence of drug, by chemistry analyzers
A definitive drug test is a detailed examination that can identify specific drugs in your system, even closely related ones. Techniques like GC/MS and LC/MS are used for high precision. This helps ensure accurate results for your safety and health.
This service was performed 30 times for 17 patientsA definitive drug test is a detailed analysis used to identify specific drugs in your system. It uses advanced techniques, such as gc/ms and lc/ms, to detect and distinguish between different drugs, even those with similar structures.
This service was performed 144 times for 33 patientsThis is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
This service was performed 129 times for 32 patientsChemistry analyzers are used to detect the presence of drugs in your system. This test involves taking a small sample of your blood or urine. The sample is then analyzed for specific substances. The results help in understanding your health condition better.
This service was performed 169 times for 35 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $22.67 for a new patient copayment and $25.87 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 02360 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $90.7
- Minimum New Patient Price $58.86
- Maximum New Patient Price $177.36
- Average New Patient Copayment $22.67
- Minimum New Patient Copayment $14.71
- Maximum New Patient Copayment $44.34
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $103.48
- Minimum Established Patient Price $19.11
- Maximum Established Patient Price $144.84
- Average Established Patient Copayment $25.87
- Minimum Established Patient Copayment $4.77
- Maximum Established Patient Copayment $36.21
* 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.
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 |
|---|---|---|
| Breast Cancer Screening | 0% | 35 |
| Cervical Cancer Screening | 0% | 122 |
| Documentation of Current Medications in the Medical Record | 75% | 1587 |
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | 10% | 177 |
| Preventive Care and Screening: Screening for Depression and Follow-Up Plan | 0% | 143 |
| Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented | 0% | 482 |
| Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | 0% | 354 |
| Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | 0% | 354 |
Reviews for MICHAEL PATRICK MACDONALD NP
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
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 1124597588, we treat the final digit (8) 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 62. The final step is to find the difference between that total and the next multiple of ten (70 - 62 = 8).
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 62 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 2 providers are registered at the same or a nearby location.
PLYMOUTH, MA 02360
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1124597588, enumerated as an "individual" on November 15, 2018.
The provider is located at 1 BUMPS POND ROAD PLYMOUTH, MA 02360 and the phone number is (508) 291-2441.
Nurse Practitioner with taxonomy code 363LP2300X and a focus in Primary Care.
The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield. Please consult your insurance carrier or call the provider to verify.
