MICHAEL LI MD
NPI 1154435006
Internal Medicine in Martinsburg, WV

NPI Status: Active since August 18, 2006

Contact Information

99 TAVERN RD
MARTINSBURG, WV
ZIP 25401
Phone: (304) 263-4999

NPI Profile Information
Primary Taxonomy
Secondary Taxonomies
Insurance Plans Accepted
Secondary Locations
Medicare Participation & PECOS Status
Areas of Expertise
Durable Medical Equipment
Physician Visit Costs
Quality Reporting
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Male
Internal Medicine
Accepts Insurance
PECOS Enrolled
Medicare Quality Reporting

About MICHAEL LI

This page provides the complete NPI Profile along with additional information for Michael Li, an internist established in Martinsburg, West Virginia with a medical specialization in Internal Medicine. The healthcare provider is registered in the NPI registry with number 1154435006 assigned on August 2006. The practitioner's primary taxonomy code is 207R00000X with license number 0101247739 (VA). The provider is registered as an individual and his NPI record was last updated 2 years ago.

NPI: 1154435006
Provider Name: MICHAEL LI MD
Gender: Male
Entity Type: Individual
Location Address: 99 TAVERN RD MARTINSBURG, WV 25401
Location Phone: (304) 263-4999
Mailing Address: 511 STONYMEADE DR WINCHESTER, VA 22602
Mailing Phone: (540) 678-3588
Mailing Fax
Is Sole Proprietor?: No
Enumeration Date: 08-18-2006
Last Update Date: 12-12-2023
Code Navigator

An internist like Michael Li 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.

Location Map

Secondary Locations

1330 Amherst St
Winchester, VA 22601
(540) 722-2369

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: Internal Medicine
Taxonomy Code: 207R00000X
Type: Allopathic & Osteopathic Physicians
License No.: 0101247739
License State: VA
Taxonomy Description: A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No.	Taxonomy Code	Type	Classification / Specialization	License No. (State)
1	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine	2006-01239 (NC)
2	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine	25245 (WV)

Insurance Plans Accepted

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

Highmark Blue Cross Blue Shield West Virginia

my Blue Access WV Major Events PPO Catastrophic 10600 - 3 Free PCP Visits - PPO
my Blue Access WV PPO Bronze 3800 - PPO
my Blue Access WV PPO Bronze 3800 + Adult Dental and Vision - PPO
my Blue Access WV PPO Bronze 9200 - PPO
my Blue Access WV PPO Gold 0 - PPO
my Blue Access WV PPO Gold 0 + Adult Dental and Vision - PPO
my Blue Access WV PPO Gold 1700 HSA - PPO
my Blue Access WV PPO Premier Gold 0 - PPO
my Blue Access WV PPO Premier Gold 0 + Adult Dental and Vision - PPO
my Blue Access WV PPO Premier Silver 0 - PPO
my Blue Access WV PPO Premier Silver 0 + Adult Dental and Vision - PPO
my Blue Access WV PPO Standard Bronze 7500 - PPO
my Blue Access WV PPO Standard Gold 2000 - PPO
my Blue Access WV PPO Standard Gold 2000 + Adult Dental and Vision - PPO
my Blue Access WV PPO Standard Silver 6000 - PPO

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

Medicare Participation & PECOS Enrollment Status

Michael Li 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
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

Provider Referred Orders for Durable Medical Equipment, Devices & Supplies

The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.

Orthotic Devices

DME-Orthotic Devices (DF000N)
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) (HCPCS:A4314)
1 DME suppliers used 15 Medicare Claims 15 Services Paid
DME-Orthotic Devices (DF000N)
Urinary catheter anchoring device, leg strap, each (HCPCS:A4334)
1 DME suppliers used 12 Medicare Claims 12 Services Paid
DME-Orthotic Devices (DF000N)
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each (HCPCS:A4357)
1 DME suppliers used 15 Medicare Claims 15 Services Paid
DME-Orthotic Devices (DF010N)
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each (HCPCS:A4385)
1 DME suppliers used 13 Medicare Claims 260 Services Paid
DME-Orthotic Devices (DF010N)
Ostomy skin barrier, pectin-based, paste, per ounce (HCPCS:A4406)
1 DME suppliers used 13 Medicare Claims 52 Services Paid
DME-Orthotic Devices (DF010N)
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each (HCPCS:A4414)
1 DME suppliers used 13 Medicare Claims 260 Services Paid
DME-Orthotic Devices (DF010N)
Ostomy pouch, drainable; with barrier attached, (1 piece), each (HCPCS:A5061)
1 DME suppliers used 13 Medicare Claims 260 Services Paid
DME-Orthotic Devices (DF010N)
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each (HCPCS:A5063)
1 DME suppliers used 13 Medicare Claims 260 Services Paid

Durable Medical Equipment

DME-Medical/Surgical Supplies (DA000N)
Adhesive, liquid or equal, any type, per oz (HCPCS:A4364)
1 DME suppliers used 13 Medicare Claims 52 Services Paid
DME-Medical/Surgical Supplies (DA000N)
Tape, non-waterproof, per 18 square inches (HCPCS:A4450)
1 DME suppliers used 13 Medicare Claims 520 Services Paid

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.

Initial nursing facility visit per day, typically 45 minutes

Physician Visit Costs

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 25401 ZIP code area.

New Patients Visit Costs *

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

Average New Patient Price $124.46
Minimum New Patient Price $53.2
Maximum New Patient Price $164.59

Average New Patient Copayment $31.11
Minimum New Patient Copayment $13.3
Maximum New Patient Copayment $41.14

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

Average Established Patient Price $94.81
Minimum Established Patient Price $16.47
Maximum Established Patient Price $133.29

Average Established Patient Copayment $23.7
Minimum Established Patient Copayment $4.11
Maximum Established Patient Copayment $33.32

* 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.

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.

Quality Measure	Performance	Number of Patients
Care Plan	98%	352
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan

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 1154435006, we treat the final digit (6) 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 44. The final step is to find the difference between that total and the next multiple of ten (50 - 44 = 6).

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.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 10 → 1 + 0

Pos 4

Unchanged

Pos 5

Doubled → 8

Pos 6

Unchanged

Pos 7

Doubled → 10 → 1 + 0

Pos 8

Unchanged

Pos 9

Doubled → 0

Check

Target digit

Regular digit Doubled digit Check digit

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.

1 → 2 5 → 10 → 1 4 → 8 5 → 10 → 1 0 → 0

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 1 + 1 + 0 + 4 + 8 + 3 + 1 + 0 + 0 + 0 + 24 = 44

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 44 is 50. The difference is the calculated check digit.

50 - 44 = 6

This NPI is valid

The calculated check digit is 6, which matches the last digit of 1154435006.