DR. GERARDO SALDANA JR. O.D.
NPI 1164411195
Optometrist in Nacogdoches, TX

NPI Status: Active since October 21, 2005

Contact Information

3208 N UNIVERSITY DR
NACOGDOCHES, TX
ZIP 75965
Phone: (936) 564-7661
Fax: (936) 564-6622

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

Individual
Male
Years of Experience 24
Optometrist
Accepts Insurance
Accepts Medicare Approved Payment
PECOS Enrolled
Medicare Quality Reporting

About GERARDO SALDANA

This page provides the complete NPI Profile along with additional information for Gerardo Saldana, a provider established in Nacogdoches, Texas with a medical specialization in Optometrist and more than 24 years of experience. He graduated from University Of Houston - College Of Optometry in 2002. The healthcare provider is registered in the NPI registry with number 1164411195 assigned on October 2005. The practitioner's primary taxonomy code is 152W00000X with license number 06253TG (TX). The provider is registered as an individual and his NPI record was last updated 15 years ago.

NPI: 1164411195
Provider Name: DR. GERARDO SALDANA JR. O.D.
Gender: Male
Entity Type: Individual
Location Address: 3208 N UNIVERSITY DR NACOGDOCHES, TX 75965
Location Phone: (936) 564-7661
Location Fax: (936) 564-6622
Mailing Address: PO BOX 632600 NACOGDOCHES, TX 75963
Mailing Phone: (936) 564-7661
Mailing Fax: (936) 564-6622
Medical School Name: UNIVERSITY OF HOUSTON - COLLEGE OF OPTOMETRY
Graduation Year: 2002
Is Sole Proprietor?: No
Enumeration Date: 10-21-2005
Last Update Date: 12-23-2010
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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: Optometrist
Taxonomy Code: 152W00000X
Type: Eye and Vision Services Providers
License No.: 06253TG
License State: TX
Taxonomy Description: Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

Insurance Plans Accepted

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

Blue Cross and Blue Shield of Illinois

Blue Choice Preferred Bronze PPO? 201 - PPO
Blue Choice Preferred Bronze PPO? 701 - PPO
Blue Choice Preferred Bronze PPO? Standard - Select Rx Copays - PPO
Blue Choice Preferred Gold PPO? 204 - PPO
Blue Choice Preferred Gold PPO? Standard - Rx Copays - PPO
Blue Choice Preferred Security PPO? 200 - PPO
Blue Choice Preferred Silver PPO? 203 - PPO
Blue Choice Preferred Silver PPO? 801 - PPO
Blue Choice Preferred Silver PPO? Standard - Select Rx Copays - PPO
Blue Precision Bronze HMO? 205 - HMO

Blue Cross and Blue Shield of Montana

Blue Focus Bronze POS? 205 - POS
Blue Focus Bronze POS? 705 - POS
Blue Focus Bronze POS? Standard - POS
Blue Focus Gold POS? 207 - POS
Blue Focus Gold POS? Standard - POS
Blue Focus Silver POS? 206 - POS
Blue Focus Silver POS? Standard - POS
Blue Preferred Bronze PPO? 201 - PPO
Blue Preferred Bronze PPO? 202 - PPO
Blue Preferred Bronze PPO? Standard - PPO

Blue Cross and Blue Shield of Oklahoma

Blue Advantage Bronze PPO? 202 - PPO
Blue Advantage Bronze PPO? 203 - PPO
Blue Advantage Bronze PPO? Standard - PPO
Blue Advantage Gold PPO? 309 - PPO
Blue Advantage Gold PPO? 604 - PPO
Blue Advantage Gold PPO? Standard - PPO
Blue Advantage Silver PPO? 204 - PPO
Blue Advantage Silver PPO? 501 - PPO
Blue Advantage Silver PPO? Standard - PPO
Blue Preferred Bronze PPO? Standard - PPO

Blue Cross and Blue Shield of Texas

Blue Advantage Bronze HMO? 204 - HMO
Blue Advantage Bronze HMO? 301 - HMO
Blue Advantage Bronze HMO? Standard - HMO
Blue Advantage Gold HMO? 206 - HMO
Blue Advantage Gold HMO? 603 - HMO
Blue Advantage Gold HMO? Standard - HMO
Blue Advantage Plus Bronze? 303 - POS
Blue Advantage Plus Bronze? 305 - POS
Blue Advantage Plus Bronze? Standard - POS
Blue Advantage Plus Gold? 203 - POS

UnitedHealthcare

UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care) - HMO
UHC Bronze Standard - HMO
UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx) - HMO
UHC Bronze Value+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision) - HMO
UHC Gold Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx) - HMO
UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision) - HMO
UHC Gold Standard - HMO
UHC Gold Standard $0 Indiv Ded ($0 Virtual Urgent Care) - HMO
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx) - HMO
UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision) - HMO

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

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

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State	Identifier Issuer
8A9242	MEDICARE ID-TYPE UNSPECIFIED (04)	TX
06253TG	OTHER (01)	TX	TX LICENSE
154278902	MEDICAID (05)	TX
U92271	MEDICARE UPIN (02)	TX

Medicare Participation & PECOS Enrollment Status

Gerardo Saldana 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.

Gerardo Saldana 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) and a Home Health Agency (HHA).

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: 3779608617
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: I20100915000411
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: No

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.

Established patient complete exam of visual system
Established patient problem focused exam of visual system
Evaluation of eye adaptation to light and dark
Exam of visual field with extended testing
Imaging of optic nerve
Imaging of retina
New patient complete exam of visual system
Photography of the retina
Removal of cataract with insertion of prosthetic lens

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $31.6 for a new patient copayment and $17.13 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 75965 ZIP code area.

New Patients Visit Costs *

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

Average New Patient Price $126.4
Minimum New Patient Price $54.84
Maximum New Patient Price $166.88

Average New Patient Copayment $31.6
Minimum New Patient Copayment $13.71
Maximum New Patient Copayment $41.72

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

Average Established Patient Price $68.55
Minimum Established Patient Price $17.52
Maximum Established Patient Price $136.11

Average Established Patient Copayment $17.13
Minimum Established Patient Copayment $4.38
Maximum Established Patient Copayment $34.02

* 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
Diabetes: Eye Exam	4%	269
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 exam (no evidence of retinopathy) in the 12 months prior to the measurement period
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care	75%	44
Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months
Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy	65%	55
Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months
Documentation of Current Medications in the Medical Record	89%	2320
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
Participation in a QCDR, that promotes collaborative learning network opportunities that are interactive.	Yes	N/A
Participation in a QCDR, that promotes collaborative learning network opportunities that are interactive.
Participation in a QCDR, that promotes implementation of patient self-action plans.	Yes	N/A
Participation in a QCDR, that promotes implementation of patient self-action plans.
Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation	44%	55
Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits within 12 months
Security Risk Analysis	Yes	N/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 EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.
Use of QCDR data for quality improvement such as comparative analysis reports across patient populations	Yes	N/A
Participation in a QCDR, clinical data registries, or other registries run by other government agencies such as FDA, or private entities such as a hospital or medical or surgical society. Activity must include use of QCDR data for quality improvement (e.g., comparative analysis across specific patient populations for adverse outcomes after an outpatient surgical procedure and corrective steps to address adverse outcome).

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.
1	1	6	4	4	1	1	1	9	5
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	1	12	4	8	1	2	1	18
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 1 + 1 + 2 + 4 + 8 + 1 + 2 + 1 + 1 + 8 + 24 = 55
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 55 = 5									5

The NPI number 1164411195 is valid because the calculated check digit 5 using the Luhn validation algorithm matches the last digit of the original NPI number.