MICHAEL PAUL SHERMAN M.D., PHD
NPI 1164643359
Internal Medicine - Hematology & Oncology in Walnut Creek, CA
Quality Rating: 0 out of 100 score
NPI Status: Active since May 02, 2007
Contact Information
500 LENNON LN
WALNUT CREEK, CA
ZIP 94598
Phone: (925) 939-9610
- Individual
- Male
- Years of Experience 33
- Internal Medicine
- Hematology & Oncology
- Accepts Medicare Approved Payment
- PECOS Enrolled
- Medicare Quality Reporting
About MICHAEL SHERMAN
This page provides the complete NPI Profile along with additional information for Michael Sherman, an internist established in Walnut Creek, California with a medical specialization in Internal Medicine, focusing in hematology & oncology and more than 33 years of experience. He graduated from State University Of New York At Stony Brook, School Of Medicine in 1994. The healthcare provider is registered in the NPI registry with number 1164643359 assigned on May 2007. The practitioner's primary taxonomy code is 207RH0003X with license number G83108 (CA). The provider is registered as an individual and his NPI record was last updated 17 years ago.
- NPI
- 1164643359
- Provider Name
- MICHAEL PAUL SHERMAN M.D., PHD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 500 LENNON LN WALNUT CREEK, CA 94598
- Location Phone
- (925) 939-9610
- Mailing Address
- 500 LENNON LN WALNUT CREEK, CA 94598
- Mailing Phone
- (925) 939-9610
- Medical School Name
- STATE UNIVERSITY OF NEW YORK AT STONY BROOK, SCHOOL OF MEDICINE
- Graduation Year
- 1994
- Is Sole Proprietor?
- No
- Enumeration Date
- 05-02-2007
- Last Update Date
- 09-23-2009
- Code Navigator
An internist like Michael Sherman 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
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 Hematology & Oncology
- Taxonomy Code
- 207RH0003X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- G83108
- License State
- CA
- Taxonomy Description
- An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
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 |
|---|---|---|---|
| 00G831082 | MEDICARE PIN (08) | CA |
Medicare Participation & PECOS Enrollment Status
Michael Sherman 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.
Michael Sherman 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: 9436043072
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: I20040212000766
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 additional new drug or substance into vein using push technique
Administration of additional new drug or substance into vein, 1 hour or less
Administration of chemotherapy into vein, 1 hour or less
Administration of chemotherapy into vein, each additional hour
Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle
Administration of influenza virus vaccine
Application of on-body injector for under skin injection
Biopsy and aspiration of bone marrow sample for diagnosis
Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m servic
Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted l
Ct scan of abdomen and pelvis with contrast
Ct scan of chest with contrast
Ct scan of chest without contrast
Drawing of blood for a medical problem
Established patient office or other outpatient visit, 20-29 minutes
Established patient office or other outpatient visit, 30-39 minutes
Established patient office or other outpatient visit, 40-54 minutes
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries
Follow-up hospital inpatient care per day, typically 35 minutes
Influenza vaccine split virus, preservative free
Infusion into a vein for hydration, 31-60 minutes
Infusion into a vein for hydration, each additional hour
Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less
Infusion into a vein for therapy, prevention, or diagnosis, additional sequential infusion, 1 hour or less
Infusion into a vein for therapy, prevention, or diagnosis, each additional hour
Infusion, normal saline solution , 1000 cc
Initial hospital inpatient care per day, typically 70 minutes
Injection of additional new drug or substance into vein
Injection of drug or substance into vein
Injection of drug or substance under skin or into muscle
Injection, carboplatin, 50 mg
Injection, darbepoetin alfa, 1 microgram (non-esrd use)
Injection, denosumab, 1 mg
Injection, dexamethasone sodium phosphate, 1 mg
Injection, diphenhydramine hcl, up to 50 mg
Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use)
Injection, fluorouracil, 500 mg
Injection, fosaprepitant, 1 mg
Injection, granisetron hydrochloride, 100 mcg
Injection, heparin sodium, (heparin lock flush), per 10 units
Injection, hydrocortisone sodium succinate, up to 100 mg
Injection, levoleucovorin, not otherwise specified, 0.5 mg
Injection, magnesium sulfate, per 500 mg
Injection, oxaliplatin, 0.5 mg
Injection, palonosetron hcl, 25 mcg
Injection, pegfilgrastim, excludes biosimilar, 0.5 mg
Injection, pegfilgrastim-apgf, biosimilar, (nyvepria), 0.5 mg
Injection, romiplostim, 10 micrograms
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg
Injection, zoledronic acid, 1 mg
Irrigation of implanted venous access drug delivery device
Leuprolide acetate (for depot suspension), 7.5 mg
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml
New patient office or other outpatient visit, 60-74 minutes
Nuclear medicine study from skull base to mid-thigh with ct scan
Nuclear medicine study whole body with ct scan
Piflufolastat f-18, diagnostic, 1 millicurie
Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or
Telephone medical discussion with physician, 21-30 minutes
This procedure involves injecting a new medication or substance directly into your vein using a method called the 'push' technique. It's a quick way to deliver medication into your bloodstream for fast-acting relief or treatment.
This service was performed 165 times for 21 patientsThis procedure involves introducing a new drug or substance into your vein, typically via an IV drip. It lasts for an hour or less. This method allows the substance to quickly reach your bloodstream, ensuring rapid and effective treatment.
This service was performed 247 times for 33 patientsChemotherapy 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 663 times for 74 patientsChemotherapy 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 274 times for 33 patientsThis procedure involves the injection of hormone-based anti-cancer drugs under the skin or into a muscle. These medications help to slow down or stop the growth of certain types of cancer cells. The process is usually quick and can be performed in a clinic or hospital.
This service was performed 205 times for 25 patientsThe administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
This service was performed 56 times for 55 patientsAn on-body injector is a device used to deliver medication under the skin. It's applied to a clean area of skin, usually the abdomen or back of the arm. The device is activated to inject the medication slowly, ensuring a steady absorption. It's a painless, safe, and effective way to administer certain types of medication.
This service was performed 122 times for 28 patientsA bone marrow biopsy and aspiration is a procedure where a small amount of bone marrow is removed for testing. It involves inserting a needle into a bone, typically the hip, to collect a sample. It can help diagnose various diseases and monitor treatment effectiveness.
This service was performed 22 times for 22 patientsA virtual check-in is a short online or phone consultation with your healthcare provider. It's for established patients and isn't related to a recent appointment. It's a convenient way to discuss health concerns without needing to visit the office in person.
This service was performed 31 times for 29 patientsChemotherapy is a treatment method that uses drugs to destroy cancer cells. In the office, a pump is used to start an intravenous infusion of these drugs. The infusion can then be continued at home or another setting, like a rest home.
This service was performed 126 times for 15 patientsA CT scan of the abdomen and pelvis with contrast is an imaging procedure. A special dye, called contrast, is used to make certain areas more visible. This can help identify issues such as infections, tumors, or other abnormalities. The procedure is painless and usually takes about 30 minutes.
This service was performed 50 times for 39 patientsA CT scan of the chest with contrast is an imaging procedure. A special dye (contrast) is used to highlight specific areas in your body, providing clearer pictures of your chest. This helps in diagnosing conditions related to your lungs, heart, and other chest structures.
This service was performed 26 times for 23 patientsA CT scan of the chest without contrast is a non-invasive imaging procedure. It uses special X-ray equipment to produce detailed images of your chest area, including your lungs and heart. It can help diagnose conditions such as lung diseases or heart disorders. It doesn't involve any dyes or contrast agents.
This service was performed 79 times for 54 patientsDrawing blood is a simple procedure where a needle is inserted into a vein, usually in your arm, to collect a small sample. This sample helps in diagnosing any medical issues you may have. You might feel a small prick, but overall, it's a quick and safe process.
This service was performed 130 times for 35 patientsThis 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 510 times for 337 patientsThis 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 1,529 times for 467 patientsThis service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
This service was performed 1,041 times for 296 patientsFluorodeoxyglucose F-18 FDG is a radioactive drug used in PET scans. It helps doctors see how your tissues and organs are functioning. The drug is given in a specific dose, up to 45 millicuries, depending on your body size and the type of scan.
This service was performed 355 times for 202 patientsFollow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.
This service was performed 24 times for 20 patientsThe Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
This service was performed 54 times for 53 patientsThis is a procedure where a sterile solution is administered into your vein to help restore body fluid balance. It typically lasts between 31-60 minutes. It's a safe, common treatment for dehydration or to deliver medication.
This service was performed 252 times for 21 patientsThis procedure involves delivering fluids directly into your vein to keep your body hydrated. It is typically done when oral hydration is insufficient. Each additional hour means more fluid is infused to ensure adequate hydration.
This service was performed 176 times for 17 patientsThis 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 298 times for 97 patientsThis procedure involves injecting fluids or medication directly into your vein. It's used for treatment, prevention, or diagnosis. An additional sequential infusion may be given within an hour if needed. This helps to ensure the medicine is distributed effectively in your body.
This service was performed 333 times for 47 patientsThis procedure involves delivering medication, fluids, or nutrients directly into your vein. This is done to treat, prevent, or diagnose various conditions. Each additional hour refers to the extended time you may need to receive these substances for optimal results.
This service was performed 75 times for 18 patientsAn infusion of normal saline solution, 1000 cc, is a common medical procedure. It involves introducing a saltwater solution into your bloodstream via an intravenous (IV) line. This helps to hydrate your body, correct electrolyte imbalances, and deliver medications if needed.
This service was performed 259 times for 18 patientsInitial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
This service was performed 19 times for 18 patientsThis 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 681 times for 105 patientsThis procedure involves introducing a medication or substance directly into your vein using a syringe. It's a quick and efficient way to deliver treatment throughout your body. You might feel a small prick when the needle enters. It's generally safe and effective.
This service was performed 227 times for 50 patientsThis 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 924 times for 179 patientsCarboplatin is a chemotherapy drug used to treat various types of cancer by slowing or stopping the growth of cancer cells. The 50 mg injection is administered into a vein by a healthcare professional. Side effects may occur.
This service was performed 424 times for 12 patientsDarbepoetin alfa injection is a medication used to treat anemia (low red blood cell count) often caused by chronic kidney disease or chemotherapy. It works by stimulating your body to produce more red blood cells, helping to increase your energy and well-being.
This service was performed 86,100 times for 57 patientsDenosumab 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 38,830 times for 115 patientsDexamethasone 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 3,852 times for 51 patientsDiphenhydramine HCL injection is a medicine given to alleviate symptoms of allergies, colds, or hay fever. It can also help with motion sickness and certain symptoms of Parkinson's disease. Up to 50 mg may be administered depending on your condition.
This service was performed 136 times for 34 patientsFerumoxytol injection is a treatment for iron deficiency anemia, a condition where your body lacks enough iron. It is injected into your vein to increase iron levels, aiding in the production of healthy red blood cells. This treatment is not for ESRD patients.
This service was performed 45,900 times for 38 patientsFluorouracil is a chemotherapy drug, given as an injection to treat various types of cancer. The 500 mg dose helps to stop cancer cells from growing and multiplying. You might feel some side effects, but these are typically manageable.
This service was performed 1,357 times for 17 patientsFosaprepitant is an anti-nausea medication given via injection. It's often used to prevent nausea and vomiting caused by chemotherapy. This injection blocks signals to the brain that trigger these symptoms, helping you feel better.
This service was performed 35,700 times for 38 patientsGranisetron hydrochloride is an anti-nausea medication given by injection. It helps prevent nausea and vomiting often caused by cancer treatments like chemotherapy. Its dosage is measured in micrograms (mcg).
This service was performed 2,301 times for 17 patientsHeparin sodium injection, often referred to as a heparin lock flush, is a procedure used to prevent blood clots in the veins. It involves injecting a small amount of heparin, a blood-thinning medication, into an intravenous (IV) line to keep it open and prevent blockages.
This service was performed 2,450 times for 30 patientsHydrocortisone 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 93 times for 50 patientsLevoleucovorin is a medication given via injection. It's used to lessen the harmful effects of certain medications or to treat certain types of cancer. The dose is 0.5 mg, and the specifics of the injection will be determined by your healthcare provider.
This service was performed 90,800 times for 15 patientsMagnesium sulfate injection, per 500 mg, is a medication administered to manage certain health conditions. It aids in controlling seizures in conditions like eclampsia and in managing severe asthma attacks. It's also used to prevent premature labor in pregnant women.
This service was performed 434 times for 11 patientsOxaliplatin is a chemotherapy drug that is administered via injection. It works by stopping cancer cells from growing and dividing, which helps in the treatment of certain types of cancer. The dosage is 0.5 mg, and it's important to follow your doctor's instructions for this treatment.
This service was performed 25,371 times for 14 patientsPalonosetron HCL is an injection used to prevent nausea and vomiting caused by chemotherapy. It works by blocking a natural substance (serotonin) in the body that can cause vomiting. This helps improve your comfort during cancer treatment.
This service was performed 3,760 times for 40 patientsPegfilgrastim is a medication given via injection to stimulate the production of white blood cells. It's used to prevent infections after chemotherapy. This specific dose is 0.5 mg, and it's not a biosimilar, meaning it's the original, not a copy.
This service was performed 1,560 times for 29 patientsPegfilgrastim-apgf (Nyvepria) is a biosimilar medicine given by injection. It helps your body make more white blood cells to fight infections. This is often used for patients undergoing treatments which may lower their immunity. The dosage is 0.5 mg.
This service was performed 744 times for 15 patientsRomiplostim is a medication given via injection to help your body produce more platelets, which are needed for normal blood clotting. It is commonly used in patients with chronic immune thrombocytopenia, a condition causing low platelet levels.
This service was performed 3,010 times for 11 patientsThis is a procedure where a small dose of Vitamin B-12, also known as Cyanocobalamin, is injected into your body. This vitamin is essential for nerve function and the production of red blood cells. It's often used to treat vitamin B-12 deficiency.
This service was performed 112 times for 16 patientsZoledronic 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 266 times for 43 patientsIrrigation of an implanted venous access drug delivery device is a procedure to clean or unblock the device. This device is implanted under your skin to allow easy, frequent, and long-term access to your veins for medication delivery. The process involves flushing the device with a sterile solution to ensure it works properly.
This service was performed 23 times for 17 patientsLeuprolide acetate is a medication that helps regulate certain hormone levels in your body. It's injected into your muscle once a month. This treatment can help manage various health conditions related to hormone imbalance. Always follow your doctor's instructions.
This service was performed 112 times for 13 patientsLow osmolar contrast material with 300-399 mg/ml iodine concentration is a diagnostic tool used in imaging procedures. It helps to enhance the visibility of specific areas in the body, aiding in accurate diagnosis. It's safe and generally well-tolerated by patients.
This service was performed 5,400 times for 41 patientsThis is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.
This service was performed 97 times for 97 patientsA nuclear medicine study from skull base to mid-thigh with a CT scan involves using a small amount of radioactive material and CT imaging to examine body tissues and organs. This helps detect any abnormalities by providing detailed images of the body's internal structure.
This service was performed 432 times for 276 patientsA Nuclear Medicine Study with a CT Scan is a diagnostic procedure. It uses a small amount of radioactive substance and a CT scan to create detailed images of your body. These images help doctors diagnose, monitor, and treat various conditions.
This service was performed 23 times for 19 patientsPiflufolastat F-18 is a radioactive diagnostic agent used in PET scans. It helps visualize certain cells in your body, aiding doctors in diagnosing specific conditions. This service involves injecting 1 millicurie of the agent into your body.
This service was performed 972 times for 94 patientsThis service refers to extended doctor visits where your healthcare provider spends additional time evaluating and managing your health beyond the primary procedure's required time. This includes each extra 15 minutes spent by the physician on the same day as the primary service.
This service was performed 86 times for 70 patientsThis service involves a 21-30 minute phone conversation with a physician. It's a chance for you to discuss your health concerns, symptoms or treatment plans. It's similar to an in-person consultation, but conducted over the phone for your convenience and safety.
This service was performed 14 times for 14 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $50.58 for a new patient copayment and $29.87 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 94598 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99205
- Average New Patient Price $202.35
- Minimum New Patient Price $69
- Maximum New Patient Price $202.35
- Average New Patient Copayment $50.58
- Minimum New Patient Copayment $17.25
- Maximum New Patient Copayment $50.58
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $119.48
- Minimum Established Patient Price $23.44
- Maximum Established Patient Price $166.46
- Average Established Patient Copayment $29.87
- Minimum Established Patient Copayment $5.86
- Maximum Established Patient Copayment $41.61
* 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 0, 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.
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Final Score: 0 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.
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Quality Score: 0
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.
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Promoting Interoperability Score: 0
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: 0
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.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Care Plan | 100% | 877 |
| 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 | ||
| Colorectal Cancer Screening | 45% | 860 |
| Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer | ||
| Documentation of Current Medications in the Medical Record | 94% | 4316 |
| 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 | ||
| Immunization Registry Reporting | Yes | N/A |
| The MIPS eligible clinician is in active engagement with a public health agency to submit immunization data. | ||
| Medication Reconciliation | 100% | 50 |
| The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician. | ||
| Oncology: Medical and Radiation - Pain Intensity Quantified | 96% | 1351 |
| Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified | ||
| Oncology: Medical and Radiation - Plan of Care for Pain | 50% | 218 |
| Percentage of visits for patients, regardless of age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy who report having pain with a documented plan of care to address pain | ||
| Pain Assessment and Follow-Up | 91% | 4316 |
| Percentage of visits for patients aged 18 years and older with documentation of a pain assessment using a standardized tool(s) on each visit AND documentation of a follow-up plan when pain is present | ||
| Patient-Specific Education | 39% | 722 |
| The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician. | ||
| Pneumococcal Vaccination Status for Older Adults | 81% | 907 |
| Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine | ||
| Preventive Care and Screening: Influenza Immunization | 43% | 1406 |
| Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization | ||
| Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | 92% | 24 |
| 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 24/7 Access to MIPS Eligible Clinicians or Groups Who Have Real-Time Access to Patient's Medical Record | Yes | N/A |
| • Provide 24/7 access to MIPS eligible clinicians, groups, or care teams for advice about urgent and emergent care (e.g., MIPS eligible clinician and care team access to medical record, cross-coverage with access to medical record, or protocol-driven nurse line with access to medical record) that could include one or more of the following: • Expanded hours in evenings and weekends with access to the patient medical record (e.g., coordinate with small practices to provide alternate hour office visits and urgent care); • Use of alternatives to increase access to care team by MIPS eligible clinicians and groups, such as e-visits, phone visits, group visits, home visits and alternate locations (e.g., senior centers and assisted living centers); and/or Provision of same-day or next-day access to a consistent MIPS eligible clinician, group or care team when needed for urgent care or transition management. | ||
| Provide Patient Access | 100% | 722 |
| At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information. | ||
| Secure Messaging | 1% | 722 |
| For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period. | ||
| 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. | ||
| Specialized Registry Reporting | Yes | N/A |
| The MIPS eligible clinician is in active engagement to submit data to specialized registry. To earn a 5 % bonus in the promoting interoperability performance category score for submitting to one or more public health or clinical data registries also attest to PI_TRANS_PHCDRR_3_MULTI. | ||
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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 1164643359, we treat the final digit (9) 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 51. The final step is to find the difference between that total and the next multiple of ten (60 - 51 = 9).
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.
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.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 51 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 15 providers are registered at the same or a nearby location.
WALNUT CREEK, CA 94598
WALNUT CREEK, CA 94598
WALNUT CREEK, CA 94598
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1164643359, enumerated as an "individual" on May 02, 2007.
The provider is located at 500 LENNON LN WALNUT CREEK, CA 94598 and the phone number is (925) 939-9610.
Internal Medicine with taxonomy code 207RH0003X and a focus in Hematology & Oncology.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.