CLARA RIVERA NPI 1205815339

Plastic Surgery in Forest Hills, NY

NPI 1205815339 Individual Female Years of Experience 42 Plastic Surgery PECOS Enrolled Accepts Medicare Approved Payment MIPS Quality Score 91.4

About CLARA RIVERA

Clara Rivera is a provider established in Forest Hills, New York and her medical specialization is plastic surgery with more than 42 years of experience. The NPI number of Clara Rivera is 1205815339 and was assigned on January 2006. The practitioner's primary taxonomy code is 208200000X with license number 161107 (NY). The provider is registered as an individual and her NPI record was last updated 14 years ago.

Clara Rivera is enrolled in PECOS and is eligible to order or refer healthcare 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

Clara Rivera 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 she has hospital affiliations with Lincoln Medical & Mental Health Center and Wyckoff Heights Medical Center.

The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 91.4, 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 typical physician office visit costs for Medicare beneficiaries in this area are: $27.51 for a new patient copayment and $22.15 for an established patient copayment.

NPI

1205815339

Provider Name CLARA RIVERA
Provider Location Address11247 QUEENS BLVD SUITE 106 FOREST HILLS, NY 11375
Provider Mailing Address11247 QUEENS BLVD SUITE 106 FOREST HILLS, NY 11375
GenderFemale
NPI Entity TypeIndividual
Medical School NameOTHER
Graduation Year1980
Is Sole Proprietor?Yes
Is Organization Subpart?N/A
Enumeration Date01-17-2006
Last Update Date02-05-2008


Primary Taxonomy

Taxonomy Code208200000X
ClassificationPlastic Surgery
TypeAllopathic & Osteopathic Physicians
License No.161107
License StateNY
Taxonomy DescriptionA plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.

Business Address

CLARA RIVERA
11247 QUEENS BLVD
SUITE 106
FOREST HILLS, NY
ZIP 11375
Phone: (718) 261-1759

Get Directions


Mailing Address

CLARA RIVERA
11247 QUEENS BLVD
SUITE 106
FOREST HILLS, NY
ZIP 11375
Phone: (718) 261-1759



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 ID2961419742
PECOS Enrollment IDI20060320000565
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

Physician Office Visit Costs

The provider accepts as payment the Medicare approved amount. Medicare beneficiaries should not be billed for more than the Medicare deductible and coinsurance amounts. Medicare pricing is usually a reference point for private insurance covered patients. The prices below reflect the costs for new and established patients in the 11375 ZIP code area.

New Patients Office Visits Costs *
Most Utilized Procedure Code for new patients office visits: 99203
Minimum New Patient Pricing Maximum New Patient Pricing Typical New Patient Pricing
$71.8 $216 $110.06
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$17.95 $54 $27.51
Established Patients Office Visits Costs *
Most Utilized Procedure Code for established patients office visits: 99213
Minimum Established Patient Pricing Maximum Established Patient Pricing Typical Established Patient Pricing
$22.16 $174.92 $88.6
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$5.54 $43.73 $22.15

* The physician office visit costs information is obtained by Medicare's 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 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% 92.9
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% 66.4
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 - 91.4
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.

  • 39Injection, triamcinolone acetonide, not otherwise specified, 10 mg (HCPCS:J3301)

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. Clara Rivera is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
LINCOLN MEDICAL & MENTAL HEALTH CENTER234 EAST 149TH STREET
BRONX, NY 10451
(718) 579-5000Acute Care Hospitals330080
WYCKOFF HEIGHTS MEDICAL CENTER374 STOCKHOLM STREET
BROOKLYN, NY 11237
(718) 963-7272Acute Care Hospitals330221

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1174400000XOther Service ProvidersSpecialist161107NYNo

Taxonomy Description: an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

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
01055009MEDICAID (05)NY
38F221MEDICARE PIN (08)NY
01648MEDICARE PIN (08)NY
F08621MEDICARE UPIN (02)NY

Other Providers at the same location


The following 14 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1366443863 PREM SHANKER MISRA MD
Individual
Internal Medicine11247 QUEENS BLVD STE 108
FOREST HILLS, NY 11375
(718) 793-3838
1922088053CLARA M. RIVERA PHYSICIAN PC
Organization
Specialist11247 QUEENS BLVD SUITE 106
FOREST HILLS, NY 11375
(718) 261-1759
1073653390P. BADER & N. GONDAL M.D. , P.C.
Organization
Internal Medicine (Hematology & Oncology)11247 QUEENS BLVD STE 209
FOREST HILLS, NY 11375
(718) 263-7766
1558498055MS. ELI JIANG L.AC
Individual
Acupuncturist11247 QUEENS BLVD SUITE 203
FOREST HILLS, NY 11375
(718) 501-5888
1699983767DR. BRIAN JOSHUA KLARMAN DC
Individual
Chiropractor (Internist)11247 QUEENS BLVD SUITE 203
FOREST HILLS, NY 11375
(718) 316-8491
1003040114MS. MAXINE L BROOKS CNM, NP
Individual
Nurse Practitioner (Women's Health)11247 QUEENS BLVD SUITE 102
FOREST HILLS, NY 11375
(718) 263-2986
1669706966EASTERN CARE ACUPUNCTURE P.C
Organization
Acupuncturist11247 QUEENS BLVD SUITE 203
FOREST HILLS, NY 11375
(718) 501-5888
1730410317GAAMA MEDICAL CARE PC
Organization
Orthopaedic Surgery11247 QUEENS BLVD SUITE 207
FOREST HILLS, NY 11375
(718) 268-0808
1407121536 RICHARD BASSIN M.D.
Individual
Surgery11247 QUEENS BLVD 204
FOREST HILLS, NY 11375
(305) 321-1226
1346473071DR. KISHAN A PATEL
Individual
Psychiatry & Neurology (Neurology)11247 QUEENS BLVD SUITE 206
FOREST HILLS, NY 11375
(718) 544-4200
1184868531DR. MICHAEL ROBERT JURKOWICH M.D.
Individual
Physical Medicine & Rehabilitation11247 QUEENS BLVD SUITE 206
FOREST HILLS, NY 11375
(718) 544-4200
1962775882COMPLETE NEUROLOGICAL CARE PC
Organization
Psychiatry & Neurology (Neurology)11247 QUEENS BLVD STE 206
FOREST HILLS, NY 11375
(718) 544-4200
1063507960 STEPHEN B. CHERNICK DPM
Individual
Podiatrist11247 QUEENS BLVD SUITE 104/105
FOREST HILLS, NY 11375
(718) 793-3223
1073648838ELENA OCHER MEDICAL PC
Organization
Medical Genetics, Ph.D. Medical Genetics11247 QUEENS BLVD
FOREST HILLS, NY 11375
(718) 268-2199

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
The code describing 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.