DR. JOHN M. WILSON M.D. NPI 1164423836

Psychiatry & Neurology - Psychiatry in Lynchburg, VA

Individual Male Years of Experience 39 Psychiatry & Neurology Psychiatry PECOS Enrolled Accepts Medicare Approved Payment MIPS Quality Score 98.3

About DR. JOHN M. WILSON M.D.

John Wilson is a provider established in Lynchburg, Virginia and his medical specialization is Psychiatry & Neurology with a focus in psychiatry with more than 39 years of experience. He graduated from University Of Illinois College Of Med (chi/peor/rock/chm-urb) in 1984. The NPI number of John Wilson is 1164423836 and was assigned on August 2005. The practitioner's primary taxonomy code is 2084P0800X with license number 0101056617 (VA). The provider is registered as an individual and his NPI record was last updated 14 years ago.

A psychiatrist like Dr. John M. Wilson M.d. are primary mental health physicians diagnose and treat mental illnesses through psychotherapy, psychoanalysis, hospitalization and medication. Psychiatrist help patients find solutions through changes in their behavioral patterns, explorations of experiences, group and family therapy.

NPI

1164423836

Provider NameDR. JOHN M. WILSON M.D.
Provider Location Address3300 RIVERMONT AVE LYNCHBURG, VA 24503
Provider Mailing Address1204 FENWICK DR LYNCHBURG, VA 24502
GenderMale
NPI Entity TypeIndividual
Medical School NameUNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduation Year1984
Is Sole Proprietor?No
Enumeration Date08-03-2005
Last Update Date03-13-2008



John Wilson 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.

John Wilson 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 Centra Health - Lynchburg Gen Hospital.

The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 98.3, 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.



Primary Taxonomy

Taxonomy Code2084P0800X
ClassificationPsychiatry & Neurology
TypeAllopathic & Osteopathic Physicians
SpecializationPsychiatry
License No.0101056617
License StateVA
Taxonomy DescriptionA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

Business Address

DR. JOHN M. WILSON M.D.
3300 RIVERMONT AVE
LYNCHBURG, VA
ZIP 24503
Phone: (434) 200-5999

Get Directions


Mailing Address

DR. JOHN M. WILSON M.D.
1204 FENWICK DR
LYNCHBURG, VA
ZIP 24502
Phone:


PECOS Enrollment and Medicare Participation

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 ID5193747301
PECOS Enrollment IDI20051230000322
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

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% 83.8
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 - 98.3
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.

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.

  • 59Psychotherapy, 60 minutes with patient and/or family member (HCPCS:90837)
  • 18Psychotherapy, 45 minutes with patient and/or family member (HCPCS:90834)
  • 11Psychiatric diagnostic evaluation (HCPCS:90791)

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. John Wilson is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
CENTRA HEALTH - LYNCHBURG GEN HOSPITAL1901 TATE SPRINGS ROAD
LYNCHBURG, VA 24501
(434) 200-4789Acute Care Hospitals490021

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 Identifier Issuer
O88170OTHER (01)VASENTARA PROVIDER NUMBER
239524OTHER (01)VALUE OPTIONS PROVIDER NU
2019602OTHER (01)CIGNA BEHAVIOR PROVIDER N
B57652MEDICARE UPIN (02)VA
00W842C34MEDICARE PIN (08)
186475OTHER (01)VAANTHEM PROVIDER NUMBER
203639329001OTHER (01)VATRICARE PROVIDER NUMBER
P00283938MEDICARE PIN (08)

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.
1164423836
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2112482686
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 1 + 1 + 2 + 4 + 8 + 2 + 6 + 8 + 6 + 24 = 64
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 64 = 66

The NPI number 1164423836 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the same location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1750384137DR. JAMES CUMMINGS DUNSTAN JR. M.D.
Individual
Physical Medicine & Rehabilitation3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 947-4651
1386640266DR. THOMAS JOSEPH CARRICO M.D.
Individual
Emergency Medicine (Undersea and Hyperbaric Medicine)3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 947-1801
1699771493DR. TERRY O. MILLER M.D.
Individual
Orthopaedic Surgery3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 947-1801
1831198464DR. PATRICIA A. PLETKE M.D.
Individual
Family Medicine (Geriatric Medicine)3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 200-4651
1487654364DR. JOHN G. FISHER M.D.
Individual
Psychiatry & Neurology (Child & Adolescent Psychiatry)3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 200-5999
1871592790DR. PETER BETZ MD
Individual
Psychiatry & Neurology (Psychiatry)3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 200-5999
1699775593DR. JOHN L. HENDRICKSON M.D.
Individual
Psychiatry & Neurology (Child & Adolescent Psychiatry)3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 200-5999
1871593145DR. MICHAEL E. JUDD M.D.
Individual
Psychiatry & Neurology (Psychiatry)3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 200-5999
1932100815DR. KARA M. ROONEY M.D.
Individual
Psychiatry & Neurology (Psychiatry)3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 200-5999
1164423976 ARTHUR FRANK SELDEN PHD
Individual
Psychologist (Clinical)3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 200-5999
1669473567 MIRANDA BREIT PHD
Individual
Psychologist (Clinical)3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 200-5999
1528069267DR. RANDALL A. SCOTT
Individual
Psychiatry & Neurology (Psychiatry)3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 200-5999
1700887478 ANNE R. NEFF LPC
Individual
Counselor (Professional)3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 200-5999
1821099565DR. RICHARD W. OLIVER
Individual
Psychiatry & Neurology (Psychiatry)3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 200-5999
1568463230 GARY A. SIBCY PHD
Individual
Psychologist (Clinical)3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 200-5999
1225039316 STACEY C. FELMLEE PHD
Individual
Psychologist (Clinical)3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 200-5999
1477555332 JUDITH P CAMPBELL
Individual
Counselor (Professional)3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 200-5999
1588666291 MELISA M. STONE LPC
Individual
Counselor (Professional)3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 200-5999
1396710422DR. VERNA R SELLERS MD
Individual
Internal Medicine (Geriatric Medicine)3300 RIVERMONT AVE
LYNCHBURG, VA 24503
(434) 200-4651
1437111564DR. ALLEN MAJEWSKI MD
Individual
Pediatrics (Neonatal-Perinatal Medicine)3300 RIVERMONT AVE VA. BAPT. HOSP. NEONATOLOGY OFFICE
LYNCHBURG, VA 24503
(434) 947-4000

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
Dr. John M. Wilson M.d. is registered as an entity type code: 1. The entity type code describes the type of health care provider that is being assigned an NPI. The entity type codes are:

  • 1 = Person: individual human being who furnishes health care.
  • 2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
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.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.