STEPHEN B GROSS MD
NPI 1205893229
Orthopaedic Surgery in Westerly, RI

NPI Status: Active since April 26, 2006

Contact Information

45 WELLS ST STE 204
WESTERLY, RI
ZIP 02891
Phone: (401) 637-7929

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  • Individual
  • Male
  • Years of Experience 39
  • Orthopaedic Surgery
  • PECOS Enrolled
  • Accepts Medicare Approved Payment

About STEPHEN GROSS

Stephen Gross is a provider established in Westerly, Rhode Island and his medical specialization is Orthopaedic Surgery with more than 39 years of experience. He graduated from Geisel School Of Medicine At Dartmouth in 1985. The healthcare provider is registered in the NPI registry with number 1205893229 assigned on April 2006. The practitioner's primary taxonomy code is 207X00000X with license number MD08611 (RI). The provider is registered as an individual and his NPI record was last updated 4 years ago.

NPI1205893229
Provider NameSTEPHEN B GROSS MD
Location Address45 WELLS ST STE 204 WESTERLY, RI 02891
Location Phone(401) 637-7929
Mailing AddressPO BOX 1119 PROVIDENCE, RI 02901
GenderMale
Entity TypeIndividual
Medical School NameGEISEL SCHOOL OF MEDICINE AT DARTMOUTH
Graduation Year1985
Is Sole Proprietor?Yes
Enumeration Date04-26-2006
Last Update Date10-18-2019
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Stephen Gross 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.

The typical physician office visit costs for Medicare beneficiaries in this area are: $23.47 for a new patient copayment and $19.09 for an established patient copayment.

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

Orthopaedic Surgery

Taxonomy Code
207X00000X
Type
Allopathic & Osteopathic Physicians
License No.
MD08611
License State
RI
Taxonomy Description
An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.

PECOS Enrollment and Medicare Participation Status

Stephen Gross 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: 4880627793

    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: I20060213000740

    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

Physician Visit Costs

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 02891 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

  • Average New Patient Price $93.88
  • Minimum New Patient Price $61.15
  • Maximum New Patient Price $184.88
  • Average New Patient Copayment $23.47
  • Minimum New Patient Copayment $15.28
  • Maximum New Patient Copayment $46.22

Established Patients Visit Costs *

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

  • Average Established Patient Price $76.36
  • Minimum Established Patient Price $19.15
  • Maximum Established Patient Price $151.08
  • Average Established Patient Copayment $19.09
  • Minimum Established Patient Copayment $4.78
  • Maximum Established Patient Copayment $37.77

* 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.

Clinician Services

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 2020. The reported codes are based on the top 5 codes for each available specialty, excluding evaluation and management codes.

  • 166

    X-ray of knee, 3 views (HCPCS:73562)

  • 132

    Aspiration and/or injection of large joint or joint capsule (HCPCS:20610)

  • 64

    Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance (HCPCS:20611)

  • 61

    X-ray of hip with pelvis, 2-3 views (HCPCS:73502)

  • 53

    X-ray of shoulder, minimum of 2 views (HCPCS:73030)

  • 13

    Repair of knee joint (HCPCS:27447)

Hospital Affiliations

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical 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. Stephen Gross is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
WESTERLY HOSPITAL25 WELLS STREET
WESTERLY, RI 2891
(401) 596-6000Acute Care Hospitals

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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.
1205893229
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2205169624
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 2 + 0 + 5 + 1 + 6 + 9 + 6 + 2 + 4 + 24 = 61
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 61 = 99

The NPI number 1205893229 is valid because the calculated check digit 9 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 3 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1356440754DR. BRAD EVAN GREEN DO
Individual
Orthopaedic Surgery45 WELLS ST STE 204
WESTERLY, RI 02891
(401) 637-7929
1821577594 MATTHEW WILLARD APRN
Individual
Nurse Practitioner (Acute Care)45 WELLS ST STE 204
WESTERLY, RI 02891
(401) 637-7929
1396238176 MICHAEL MCCAULEY MD
Individual
Psychiatry & Neurology (Neurology)45 WELLS ST STE 204
WESTERLY, RI 02891
(203) 785-4085

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1205893229, enumerated in the NPI registry as an "individual" on April 26, 2006

The provider is located at 45 Wells St Ste 204 Westerly, Ri 02891 and the phone number is (401) 637-7929

The provider's speciality is Orthopaedic Surgery with taxonomy code 207X00000X

The provider has more than 39 years of experience. He graduated from Geisel School Of Medicine At Dartmouth in 1985.

Yes, as of April 05, 2024 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary 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.

Medicare beneficiaries should expect a typical cost of $93.88 with an average copayment of $23.47 for new patient appointments. Established patients should expect a typical charge of $76.36 and an average copayment of 19.09. Please review your insurance plan or contact the provider directly to determine your specific costs.

The most common procedures or services performed by this practitioner are: X-ray of knee, 3 views, Aspiration and/or injection of large joint or joint capsule, Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance, X-ray of hip with pelvis, 2-3 views, X-ray of shoulder, minimum of 2 views and Repair of knee joint.

The practitioner is affiliated to the following hospital(s): WESTERLY HOSPITAL. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

This NPI record was last updated on April 26, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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