GURUNATH RAJAPURAM M.D. NPI 1144238510
Internal Medicine - Cardiovascular Disease in Antioch, CA

About GURUNATH RAJAPURAM M.D.

Gurunath Rajapuram is an internist established in Antioch, California and his medical specialization is Internal Medicine with a focus in cardiovascular disease with more than 41 years of experience. The NPI number of Gurunath Rajapuram is 1144238510 and was assigned on August 2006. The practitioner's primary taxonomy code is 207RC0000X with license number A51558 (CA). The provider is registered as an individual and his NPI record was last updated 15 years ago.

NPI
1144238510
Provider Name GURUNATH RAJAPURAM M.D.
Location Address3737 LONE TREE WAY ANTIOCH, CA 94509
Location Phone(925) 753-1986
Mailing Address3737 LONE TREE WAY ANTIOCH, CA 94509
GenderMale
NPI Entity TypeIndividual
Medical School NameOTHER
Graduation Year1982
Is Sole Proprietor?Yes
Enumeration Date08-03-2006
Last Update Date07-08-2007

An internist like Gurunath Rajapuram M.d. is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.Gurunath Rajapuram 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.

Gurunath Rajapuram 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 Sutter Delta Medical Center and John Muir Medical Center - Concord Campus.

The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 100, 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: anticoagulant management improvements, breast cancer screening, clinical data registry reporting, colorectal cancer screening, diabetes: eye exam, diabetes: medical attention for nephropathy, documentation of current medications in the medical record, e-prescribing, falls: screening for future fall risk, immunization registry reporting, pneumococcal vaccination status for older adults, preventive care and screening: body mass index (bmi) screening and follow-up plan, preventive care and screening: tobacco use: screening and cessation intervention, provide patients electronic access to their health information, public health registry reporting, query of the prescription drug monitoring program (pdmp), security risk analysis, support electronic referral loops by receiving and incorporating health information and use of high-risk medications in the elderly.

The typical physician office visit costs for Medicare beneficiaries in this area are: $39.19 for a new patient copayment and $21.68 for an established patient copayment.



Primary Taxonomy

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.

Taxonomy Code207RC0000X
ClassificationInternal Medicine
TypeAllopathic & Osteopathic Physicians
SpecializationCardiovascular Disease
License No.A51558
License StateCA
Taxonomy DescriptionAn internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

Accepted Insurance

The NPI profile data indicates this provider might be enrolled and accepting insurance plans from the following companies or healthcare programs:

  • Medicaid
  • Medicare

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Business Address

GURUNATH RAJAPURAM M.D.
3737 LONE TREE WAY
ANTIOCH, CA
ZIP 94509
Phone: (925) 753-1986

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Mailing Address

GURUNATH RAJAPURAM M.D.
3737 LONE TREE WAY
ANTIOCH, CA
ZIP 94509
Phone: (925) 753-1986


Location Map

PECOS Enrollment and Medicare Participation Status

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 ID1759415524
PECOS Enrollment IDI20100816000434
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

Physician Office Visit Costs

The provider accepts as payment the Medicare approved amount. Medicare beneficiaries should not be billed for more than the Medicare deductible and coinsurance amounts. Medicare pricing is usually a reference point for private insurance covered patients. The prices below reflect the costs for new and established patients in the 94509 ZIP code area.

New Patients Office Visits Costs *
Most Utilized Procedure Code for new patients office visits: 99204
Minimum New Patient Pricing Maximum New Patient Pricing Typical New Patient Pricing
$69.92 $206.38 $156.78
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$17.48 $51.59 $39.19
Established Patients Office Visits Costs *
Most Utilized Procedure Code for established patients office visits: 99213
Minimum Established Patient Pricing Maximum Established Patient Pricing Typical Established Patient Pricing
$22.97 $169.96 $86.73
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$5.74 $42.49 $21.68

* The physician office visit costs information is obtained by Medicare's statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

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% 86
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 - 100
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
Anticoagulant Management ImprovementsYesN/A
Individual MIPS eligible clinicians and groups who prescribe oral Vitamin K antagonist therapy (warfarin) must attest that, for 60 percent of practice patients in the transition year and 75 percent of practice patients in Quality Payment Program Year 2 and future years, their ambulatory care patients receiving warfarin are being managed by one or more of the following improvement activities: - Patients are being managed by an anticoagulant management service, that involves systematic and coordinated care, incorporating comprehensive patient education, systematic prothrombin time (PT-INR) testing, tracking, follow-up, and patient communication of results and dosing decisions;- Patients are being managed according to validated electronic decision support and clinical management tools that involve systematic and coordinated care, incorporating comprehensive patient education, systematic PT-INR testing, tracking, follow-up, and patient communication of results and dosing decisions;- For rural or remote patients, patients are managed using remote monitoring or telehealth options that involve systematic and coordinated care, incorporating comprehensive patient education, systematic PT-INR testing, tracking, follow-up, and patient communication of results and dosing decisions; and/or- For patients who demonstrate motivation, competency, and adherence, patients are managed using either a patient self-testing (PST) or patient-self-management (PSM) program.
Breast Cancer Screening 36% 200
Percentage of women 50 - 74 years of age who had a mammogram to screen for breast cancer
Clinical Data Registry ReportingYesN/A
The MIPS eligible clinician is in active engagement to submit data to a clinical data registry.
Colorectal Cancer Screening 33% 556
Percentage of patients 50-75 years of age who had appropriate screening for colorectal cancer
Diabetes: Eye Exam 9% 210
Percentage of patients 18 - 75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal or dilated eye exam (no evidence of retinopathy) in the 12 months prior to the measurement period
Diabetes: Medical Attention for Nephropathy 92% 210
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
Documentation of Current Medications in the Medical Record 98% 3230
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
e-Prescribing 100% 1241
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using CEHRT.
Falls: Screening for Future Fall Risk 2% 725
Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period
Immunization Registry ReportingYesN/A
The MIPS eligible clinician is in active engagement with a public health agency to submit immunization data and receive immunization forecasts and histories from the public health immunization registry/immunization information system (IIS).
Pneumococcal Vaccination Status for Older Adults 35% 725
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 29% 1045
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounterNormal Parameters: Age 18 years and older BMI => 18.5 and < 25 kg/m2
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 14% 56
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Provide Patients Electronic Access to Their Health Information 100% 1083
For at least one unique patient seen by the MIPS eligible clinician: (1) The patient (or the patient-authorized representative) is provided timely access to view online, download, and transmit his or her health information; and (2) The MIPS eligible clinician ensures the patient's health information is available for the patient (or patient-authorized representative) to access using any application of their choice that is configured to meet the technical specifications of the Application Programing Interface (API) in the MIPS eligible clinician's certified electronic health record technology (CEHRT).
Public Health Registry ReportingYesN/A
The MIPS eligible clinician is in active engagement with a public health agency to submit data to public health registries.
Query of the Prescription Drug Monitoring Program (PDMP)YesN/A
For at least one Schedule II opioid electronically prescribed using CEHRT during the performance period, the MIPS eligible clinician uses data from CEHRT to conduct a query of a Prescription Drug Monitoring Program (PDMP) for prescription drug history, except where prohibited and in accordance with applicable law.
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.
Support Electronic Referral Loops By Receiving and Incorporating Health Information 2% 3837
For at least one electronic summary of care record received for patient encounters during the performance period for which a MIPS eligible clinician was the receiving party of a transition of care or referral, or for patient encounters during the performance period in which the MIPS eligible clinician has never before encountered the patient, the MIPS eligible clinician conducts clinical information reconciliation for medication, medication allergy, and current problem list.
Use of High-Risk Medications in the Elderly 14% "Inverse Quality Measure"
This is an inverse quality measure, a lower rate means the provider is rated better.
725
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted.1) Percentage of patients who were ordered at least one high-risk medication2) Percentage of patients who were ordered at least two of the same high-risk medication

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.

  • 1649Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report (HCPCS:93010)
  • 243Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function (HCPCS:93306)
  • 155Routine EKG using at least 12 leads including interpretation and report (HCPCS:93000)
  • 129Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician analysis, review, and report (HCPCS:93280)
  • 96Nuclear medicine study of vessels of heart using drugs or exercise multiple studies (HCPCS:78452)
  • 81Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart (HCPCS:93458)
  • 42Exercise or drug-induced heart and blood vessel stress test with EKG monitoring, physician interpretation and report (HCPCS:93018)
  • 30Catheter insertion of stents in major coronary artery or branch, accessed through the skin (HCPCS:92928)

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. Gurunath Rajapuram is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
SUTTER DELTA MEDICAL CENTER3901 LONE TREE WAY
ANTIOCH, CA 94509
(925) 779-7200Acute Care Hospitals50523
JOHN MUIR MEDICAL CENTER - CONCORD CAMPUS2540 EAST ST
CONCORD, CA 94520
(925) 682-8200Acute Care Hospitals50496

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
F44519MEDICARE UPIN (02)CA

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.
1144238510
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2184431652
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 1 + 8 + 4 + 4 + 3 + 1 + 6 + 5 + 2 + 24 = 60
Step 3: because the number obtained in step 2 ends in zero, the check digit is zero.
0

The NPI number 1144238510 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 9 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1982623484DR. ROBERT S CLUFF MD
Individual
Psychiatry & Neurology (Neurology)3737 LONE TREE WAY
ANTIOCH, CA 94509
(925) 754-1768
1154424299ANTIOCH MEDICAL PARK MEDICAL GROUP
Organization
Family Medicine3737 LONE TREE WAY
ANTIOCH, CA 94509
(925) 754-9223
1124121223DR. DANIEL L ZIMMERMAN MD
Individual
Obstetrics & Gynecology3737 LONE TREE WAY
ANTIOCH, CA 94509
(925) 754-9223
1518142090ANTIOCH MEDICAL PARK MEDICAL LAB
Organization
Clinical Medical Laboratory3737 LONE TREE WAY
ANTIOCH, CA 94509
(925) 754-1254
1003009440 REKHA VONTELA DDS
Individual
Dentist3737 LONE TREE WAY SUITE F
ANTIOCH, CA 94509
(925) 754-5432
1427388875REKHA VONTELA DDS
Organization
Dentist3737 LONE TREE WAY #F
ANTIOCH, CA 94509
(925) 754-5432
1225421589DANIEL L ZIMMERMAN MD, INC.
Organization
Obstetrics & Gynecology3737 LONE TREE WAY
ANTIOCH, CA 94509
(925) 754-0383
1538357579MS. CHRISTIANE ALISA PETERS NP
Individual
Nurse Practitioner (Women's Health)3737 LONE TREE WAY
ANTIOCH, CA 94509
(925) 754-9223
1942513841 JULIE KATHLEEN HOOD FNP
Individual
Nurse Practitioner (Family)3737 LONE TREE WAY
ANTIOCH, CA 94509
(925) 754-8070

Frequently Asked Questions

What is Gurunath Rajapuram M.D. NPI number?

The NPI number assigned to Gurunath Rajapuram M.D. is 1144238510, registered as an "individual" on August 03, 2006

Where is Gurunath Rajapuram M.D. located?

The provider is located at 3737 Lone Tree Way Antioch, Ca 94509 and the phone number is (925) 753-1986

Which is Gurunath Rajapuram M.D. specialty?

The provider's speciality is Internal Medicine with a focus in Cardiovascular Disease

How many years of experience does Gurunath Rajapuram M.D. have?

The provider has more than 41 years of experience.

What insurance does Gurunath Rajapuram M.D. accept?

The provider might be accepting Medicaid and Medicare. Please consult your insurance carrier or call the provider to make sure your insurance plan is currently accepted.

Is Gurunath Rajapuram M.D. registered in PECOS?

Yes, as of November 14, 2022 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a Medicare beneficiary 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.

How much is a visit to Gurunath Rajapuram M.D.?

Medicare beneficiaries should expect a typical cost of $156.78 with an average copayment of $39.19 for new patient appointments. Established patients should expect a typical charge of $86.73 and an average copayment of 21.68. Please review your insurance plan or contact the provider directly to determine your specific costs.

What are some of the services provided by Gurunath Rajapuram M.D.?

The most common procedures or services performed by this practitioner are: Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report, Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function, Routine EKG using at least 12 leads including interpretation and report, Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician analysis, review, and report, Nuclear medicine study of vessels of heart using drugs or exercise multiple studies, Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart, Exercise or drug-induced heart and blood vessel stress test with EKG monitoring, physician interpretation and report and Catheter insertion of stents in major coronary artery or branch, accessed through the skin.

Is Gurunath Rajapuram M.D. affiliated to any hospitals?

The practitioner is affiliated to the following hospitals: SUTTER DELTA MEDICAL CENTER and JOHN MUIR MEDICAL CENTER - CONCORD CAMPUS. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

How do I update my NPI information?

The NPI record of Gurunath Rajapuram M.D. was last updated on August 03, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected]
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us at: [email protected]