JOSEPH Z FORSTOT MD
NPI 1144323023
Internal Medicine - Rheumatology in Boca Raton, FL

Medicare Participation & PECOS Enrollment Status

Joseph Forstot 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.

Joseph Forstot 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: 5597758367

  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: I20100614000898

  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.

Administration of chemotherapy into vein, 1 hour or less

Chemotherapy is a treatment that uses drugs to destroy cancer cells. When administered into a vein, it's often through an IV. This procedure usually lasts 1 hour or less. You may feel a slight pinch as the needle is inserted, but it's generally painless.

This service was performed 433 times for 100 patients

Administration of chemotherapy into vein, each additional hour

Chemotherapy is a treatment method that uses drugs to destroy cancer cells. The drugs are administered into a vein, usually in the arm. Each additional hour of chemotherapy allows for more of the medication to enter your bloodstream to fight against the cancer cells.

This service was performed 122 times for 24 patients

Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle

This procedure involves giving anti-cancer drugs, which don't contain hormones, into the muscle or under the skin. These drugs help to stop the growth of cancer cells. The process is usually quick and done by a healthcare professional.

This service was performed 876 times for 450 patients

Analysis of substance using immunoassay technique, multiple step method

This procedure involves the use of an immunoassay, a highly sensitive technique, to detect and measure substances in your body. It involves multiple steps and is commonly used in diagnosing and monitoring various health conditions.

This service was performed 142 times for 107 patients

Aspiration and/or injection of fluid from large joint

This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.

This service was performed 343 times for 115 patients

Aspiration and/or injection of fluid from small joint

This procedure involves inserting a thin needle into a small joint to remove (aspirate) or inject fluid. It can help diagnose conditions, relieve discomfort, or administer medication directly into the joint. It's generally safe with minimal discomfort.

This service was performed 47 times for 20 patients

Blood creatinine level

A blood creatinine level test measures the amount of creatinine in your blood. Creatinine is a waste product that your body produces when it uses energy. High levels may indicate that your kidneys aren't working properly. This test is often used to monitor kidney health.

This service was performed 589 times for 334 patients

Body fluid cell count

A body fluid cell count is a lab test performed on a sample of body fluid, such as from the spine or abdomen. This test measures the number of certain cells in the fluid. It helps doctors detect conditions like infections, inflammation, or other medical issues.

This service was performed 60 times for 16 patients

Calcium level, total

A total calcium level test measures the amount of calcium in your blood. Calcium is essential for body functions like bone formation, nerve signal transmission, and muscle contraction. Abnormal levels may indicate conditions like bone disease or kidney disorders.

This service was performed 445 times for 295 patients

Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count

A Complete Blood Cell Count is a common test that measures various components of the blood, including red cells (carry oxygen), white cells (fight infection), and platelets (help blood clot). An automated test ensures accuracy. The differential count provides detailed information about white cell types.

This service was performed 582 times for 334 patients

Creatine kinase (cardiac enzyme) level, total

The total Creatine Kinase (CK) level test is a blood test that helps assess the health of your heart. It measures an enzyme called CK that's released into the bloodstream when heart or other muscle tissue is damaged. High levels may indicate a heart attack or muscle disorder.

This service was performed 104 times for 73 patients

Crystal identification from tissue or body fluid

Crystal identification from tissue or body fluid is a medical test that helps identify the presence of certain substances in the body. It involves analyzing samples from your body to detect crystals that may indicate health conditions like gout or kidney stones.

This service was performed 38 times for 20 patients

Dxa bone density measurement of hip, pelvis, spine

A DXA bone density measurement is a simple, quick, and non-invasive procedure that assesses the strength of your bones. This test uses X-rays to measure the amount of minerals, mainly calcium, in the hip, pelvis, and spine. It helps in early detection of osteoporosis or other bone diseases.

This service was performed 116 times for 116 patients

Established patient office or other outpatient visit, 20-29 minutes

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

This service was performed 846 times for 394 patients

Established patient office or other outpatient visit, 30-39 minutes

This 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 1,131 times for 357 patients

Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less

This is a procedure where a medical professional inserts a small tube into your vein to deliver medication, nutrients, or fluids directly into your bloodstream. This can be for treatment, prevention, or diagnosis. The process typically takes less than an hour.

This service was performed 68 times for 61 patients

Injection into tendon or ligament

An injection into a tendon or ligament involves placing medication directly into these areas to help reduce inflammation and pain. It's often used for conditions like arthritis or tendonitis. The procedure is quick and usually involves a local anesthetic.

This service was performed 34 times for 23 patients

Injection of additional new drug or substance into vein

This procedure involves introducing a new medication or substance into your bloodstream via a vein. It's typically done using a small needle. The substance can help treat various conditions or assist in diagnostic procedures. It's generally safe and monitored by professionals.

This service was performed 154 times for 43 patients

Injection of drug or substance under skin or into muscle

This procedure involves administering medication directly under the skin or into a muscle. A small needle is used to inject the drug, allowing it to be absorbed quickly into the bloodstream. It's a common method for delivering a variety of medications.

This service was performed 308 times for 185 patients

Injection of trigger points, 1-2 muscles

Trigger point injection is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. 1-2 muscles are typically treated in one session. The procedure involves injecting medications into these points to alleviate pain.

This service was performed 99 times for 49 patients

Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)

Abatacept is a medication administered via injection under a doctor's supervision. It's used to treat conditions like rheumatoid arthritis by moderating the immune system. This code applies when the doctor administers the drug, not for self-administration.

This service was performed 16,775 times for 39 patients

Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)

Certolizumab pegol is a medication injected under a doctor's supervision. It's used to treat certain inflammatory conditions like rheumatoid arthritis. The injection helps reduce symptoms like pain and swelling. Note that this drug isn't for self-administration.

This service was performed 38,400 times for 27 patients

Injection, denosumab, 1 mg

Denosumab is a medication given via injection to strengthen your bones. It works by slowing down the cells that break down bone, improving bone density and reducing the risk of fractures. It's often used for osteoporosis treatment.

This service was performed 30,241 times for 409 patients

Injection, dexamethasone sodium phosphate, 1 mg

Dexamethasone sodium phosphate is a medication given via injection. It is a type of steroid that helps reduce inflammation and immune responses. It can be used to treat a variety of conditions, such as allergies, skin conditions, arthritis, and more.

This service was performed 437 times for 101 patients

Injection, golimumab, 1 mg, for intravenous use

Golimumab is a medication given through an IV (a small tube in your vein). It helps to reduce inflammation and pain by blocking a protein in your body that causes inflammation. It's often used to treat conditions like rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.

This service was performed 11,952 times for 24 patients

Injection, hydrocortisone sodium succinate, up to 100 mg

Hydrocortisone sodium succinate injection is a medication given to treat various conditions like allergies, skin conditions, arthritis, or breathing disorders. It works by reducing inflammation and the body's immune response. The dose, up to 100 mg, depends on your condition.

This service was performed 155 times for 43 patients

Injection, infliximab, excludes biosimilar, 10 mg

Infliximab is a medication given via injection to treat certain autoimmune conditions. It works by blocking the action of a substance in your body that causes inflammation. Each dose is based on your medical condition and response to treatment.

This service was performed 4,960 times for 21 patients

Injection, ketorolac tromethamine, per 15 mg

Ketorolac tromethamine is a medication administered through injection, often used to manage moderate to severe pain. Each 15 mg dose helps to reduce hormones causing inflammation and pain in the body. It is not recommended for long-term use.

This service was performed 255 times for 31 patients

Injection, methylprednisolone acetate, 40 mg

Methylprednisolone acetate is a medication given through an injection. It's a type of corticosteroid, which reduces inflammation and immune responses. It can be used to treat various conditions like arthritis, allergies, and skin diseases. This dose is 40 mg.

This service was performed 87 times for 39 patients

Injection, methylprednisolone acetate, 80 mg

Methylprednisolone acetate is a strong anti-inflammatory medication. It is often given as an 80 mg injection to reduce inflammation and pain. It's commonly used for conditions like arthritis, allergic disorders, or other inflammatory diseases.

This service was performed 140 times for 55 patients

Injection, romosozumab-aqqg, 1 mg

Romosozumab-aqqg is a medication given by injection to treat osteoporosis in patients at high risk for fractures. It works by increasing bone mass and strength, reducing the risk of fractures.

This service was performed 38,220 times for 80 patients

Injection, tocilizumab, 1 mg

Tocilizumab is a medication administered via injection. It's used to treat certain conditions like rheumatoid arthritis by reducing inflammation in the body. It works by blocking a substance in the body that leads to inflammation.

This service was performed 32,155 times for 18 patients

Injection, triamcinolone acetonide, not otherwise specified, 10 mg

Triamcinolone acetonide is a medication used to reduce inflammation in the body. It's given as a 10 mg injection for conditions like allergies, arthritis, or skin problems. The injection helps to decrease swelling, redness, and itching.

This service was performed 171 times for 40 patients

Injection, zoledronic acid, 1 mg

Zoledronic acid is a medication given via injection to strengthen bones. It's often used in patients with osteoporosis or certain types of cancer. The injection helps reduce the risk of fractures and other bone complications.

This service was performed 240 times for 48 patients

Insertion of needle into vein for collection of blood sample

This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.

This service was performed 648 times for 358 patients

Joint fluid diagnostic test

A joint fluid diagnostic test, also known as arthrocentesis, involves extracting and analyzing fluid from a swollen joint. The test helps identify the cause of joint inflammation, such as infection, gout, or arthritis. It's a quick, safe procedure that can provide valuable information about your joint health.

This service was performed 38 times for 20 patients

Liver function blood test panel

A liver function blood test panel helps check the health of your liver. It measures various proteins, liver enzymes, and bilirubin in your blood. If these levels are too high or too low, it could signal a liver problem. It's a simple, non-invasive test that involves drawing blood.

This service was performed 298 times for 162 patients

Measurement c-reactive protein for detection of infection or inflammation

C-reactive protein (CRP) test is a blood test that checks for signs of inflammation or infection in the body. High levels of CRP often suggest that there's inflammation or a bacterial infection. This test helps in monitoring and managing conditions like arthritis and heart disease.

This service was performed 316 times for 170 patients

Measurement of antibody for assessment of autoimmune disorder, any method

This procedure measures the level of specific antibodies in your body to assess if you have an autoimmune disorder. Antibodies are proteins your immune system produces. In autoimmune disorders, these antibodies mistakenly attack your own cells. This test helps identify such conditions.

This service was performed 176 times for 66 patients

Measurement of antibody for assessment of autoimmune disorder, titer

This test measures the level of specific antibodies in your blood, which can help in the diagnosis of autoimmune disorders. A titer refers to the concentration of antibodies. High titers can indicate an active autoimmune disease.

This service was performed 34 times for 29 patients

Measurement of complement (immune system proteins), antigen,

The measurement of complement (immune system proteins) and antigen is a blood test. It helps to assess how your immune system is functioning. Complement proteins play a role in your body's immune response, and antigens trigger this response. This test helps in diagnosing and monitoring certain diseases.

This service was performed 126 times for 40 patients

Measurement of dna antibody, native or double stranded

The measurement of DNA antibody, native or double stranded, is a blood test that helps detect autoimmune disorders, such as lupus. It identifies if your body is producing antibodies against its own DNA, which can indicate an overactive immune response.

This service was performed 41 times for 26 patients

New patient office or other outpatient visit, 30-44 minutes

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

This service was performed 17 times for 17 patients

New patient office or other outpatient visit, 45-59 minutes

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

This service was performed 79 times for 79 patients

Parathormone (parathyroid hormone) level

The Parathormone level test measures the amount of parathyroid hormone in your blood. This hormone controls calcium and phosphorus levels in the body, which are vital for bone health. Abnormal levels may indicate issues like kidney disease or parathyroid gland disorders.

This service was performed 305 times for 212 patients

Phosphatase (enzyme) measurement, alkaline, isoenzymes

Alkaline phosphatase isoenzyme measurement is a blood test that helps to check the health of your liver and bones. It measures the level of certain enzymes produced by these areas. Variations in these levels may indicate a potential health issue.

This service was performed 421 times for 286 patients

Phosphate level

A phosphate level test measures the amount of phosphate in your blood. Phosphate is a chemical that contains the mineral phosphorus, crucial for energy production, muscle and nerve function, and bone growth. Imbalances may indicate kidney disease or other health issues.

This service was performed 415 times for 286 patients

Red blood cell sedimentation rate, to detect inflammation, non-automated

The Red Blood Cell Sedimentation Rate test measures how quickly red blood cells settle at the bottom of a test tube. If they settle faster than normal, it may indicate inflammation in the body. This test is non-automated, meaning it's manually performed by a lab technician.

This service was performed 321 times for 174 patients

Rheumatoid factor analysis

Rheumatoid factor analysis is a blood test utilized to help diagnose rheumatoid arthritis, an autoimmune disorder causing joint inflammation. It detects the presence of rheumatoid factor, an antibody often found in those with the condition.

This service was performed 148 times for 111 patients

Screening test for antibody to noninfectious agent

A screening test for antibodies to noninfectious agents is a medical procedure that checks your body's response to substances that are not infectious. It involves taking a blood sample to identify specific antibodies, which are proteins your body produces when it detects harmful elements.

This service was performed 37 times for 17 patients

Screening test for autoimmune disorder

A screening test for autoimmune disorders is a medical check-up that helps identify if your body's immune system is attacking its own cells. It involves a simple blood draw and analyzes various markers to detect potential issues. This test aids in early detection and effective treatment.

This service was performed 167 times for 128 patients

Urea nitrogen level to assess kidney function, quantitative

The urea nitrogen level test is a routine blood test that checks the amount of urea nitrogen in your blood to evaluate how well your kidneys are working. If the levels are higher than normal, it may indicate that your kidneys are not functioning properly.

This service was performed 586 times for 333 patients

Uric acid level, blood

A blood uric acid level test measures the amount of uric acid in your blood. Uric acid is a waste product that your body produces when it breaks down purines, substances found in your body and in certain foods. High levels may lead to gout or kidney stones.

This service was performed 32 times for 24 patients

Vitamin d-3 level

A Vitamin D-3 level test measures the amount of Vitamin D-3, a crucial nutrient, in your body. This test helps identify if your levels are too low or too high. Low levels may lead to bone weakness, while high levels could harm your kidneys. It's a simple blood test.

This service was performed 392 times for 271 patients

X-ray of hand, 2 views

An X-ray of the hand, 2 views, is a non-invasive imaging test that uses a small amount of radiation to produce pictures of the bones in your hand. Two different angles are captured to provide a comprehensive view. This helps in diagnosing injuries or conditions affecting your hand.

This service was performed 32 times for 18 patients

X-ray of knee, 3 views

An X-ray of the knee, 3 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of the knee from three different angles. This helps medical professionals to diagnose and monitor conditions like arthritis, fractures, or infections. The process is quick and painless.

This service was performed 21 times for 14 patients

X-ray of shoulder, minimum of 2 views

An X-ray of the shoulder, with a minimum of 2 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of your shoulder bones. This helps in diagnosing conditions like fractures, arthritis, or other abnormalities. The procedure is quick and painless.

This service was performed 17 times for 13 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $33.89 for a new patient copayment and $25.8 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 33486 ZIP code area.

* 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.

Overall MIPS Quality Performance

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 79.71, 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 Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS 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.

• Final Score: 79.71 out of 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.
  
  

• Quality Score: 67.48

  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 Score: 92

  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 Score: 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 activities measure category compromises 15% providers final MPIS scores.
  
  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 Score: 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.

• Cost Score: 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.

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.

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical 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. Joseph Forstot is affiliated with the following medical facilities:

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