STEPHEN B GROSS MD NPI 1205893229
Orthopaedic Surgery in Westerly, RI
About STEPHEN B GROSS MD
Stephen Gross is a provider established in Westerly, Rhode Island and his medical specialization is Orthopaedic Surgery with more than 38 years of experience. He graduated from Geisel School Of Medicine At Dartmouth in 1985. The NPI number of this provider is 1205893229 and was 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.
| NPI | 1205893229 |
| Provider Name | STEPHEN B GROSS MD |
| Location Address | 45 WELLS ST STE 204 WESTERLY, RI 02891 |
| Location Phone | (401) 637-7929 |
| Mailing Address | PO BOX 1119 PROVIDENCE, RI 02901 |
| Gender | Male |
| NPI Entity Type | Individual |
| Medical School Name | GEISEL SCHOOL OF MEDICINE AT DARTMOUTH |
| Graduation Year | 1985 |
| Is Sole Proprietor? | Yes |
| Enumeration Date | 04-26-2006 |
| Last Update Date | 10-18-2019 |
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.
Stephen Gross 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 Westerly Hospital.
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.
Primary Taxonomy
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.
| Taxonomy Code | 207X00000X |
| Classification | Orthopaedic Surgery |
| 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. |
Business Address
45 WELLS ST STE 204
WESTERLY, RI
ZIP 02891
Phone: (401) 637-7929
Mailing Address
PO BOX 1119
PROVIDENCE, RI
ZIP 02901
Location Map
PECOS Enrollment and Medicare Participation Status
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 ID | 4880627793 |
| PECOS Enrollment ID | I20060213000740 |
| 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 Imaging | Yes |
| Eligible order / refer Durable Medical Equipment | Yes |
| Eligible order / refer Home Health Agency (HHA) | Yes |
| Eligible order / refer Power Mobility Devices | Yes |
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 02891 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 |
| $61.15 | $184.88 | $93.88 |
| Minimum New Patient Copayment | Maximum New Patient Copayment | Typical New Patient Copayment |
| $15.28 | $46.22 | $23.47 |
| 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 |
| $19.15 | $151.08 | $76.36 |
| Minimum Established Patient Copayment | Maximum Established Patient Copayment | Typical Established Patient Copayment |
| $4.78 | $37.77 | $19.09 |
* 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.
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.
- 166X-ray of knee, 3 views (HCPCS:73562)
- 132Aspiration and/or injection of large joint or joint capsule (HCPCS:20610)
- 64Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance (HCPCS:20611)
- 61X-ray of hip with pelvis, 2-3 views (HCPCS:73502)
- 53X-ray of shoulder, minimum of 2 views (HCPCS:73030)
- 13Repair of knee joint (HCPCS:27447)
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. Stephen Gross is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | CMS Certification Number (CCN) | Overall Rating |
|---|---|---|---|---|---|
| WESTERLY HOSPITAL | 25 WELLS STREET WESTERLY, RI 2891 | (401) 596-6000 | Acute Care Hospitals | 410013 |
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 | 2 | 0 | 5 | 8 | 9 | 3 | 2 | 2 | 9 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 2 | 0 | 5 | 16 | 9 | 6 | 2 | 4 | |
| 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 = 9 | 9 | ||||||||
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 2 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1356440754 | DR. BRAD EVAN GREEN DO Individual | Orthopaedic Surgery | 45 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 |
Frequently Asked Questions
What is Stephen Gross MD NPI number?
The NPI number assigned to this healthcare provider is 1205893229, registered as an "individual" on April 26, 2006
Where is Stephen Gross MD located?
The provider is located at 45 Wells St Ste 204 Westerly, Ri 02891 and the phone number is (401) 637-7929
Which is Stephen Gross MD specialty?
The provider's speciality is Orthopaedic Surgery
How many years of experience does Stephen Gross MD have?
The provider has more than 38 years of experience. He graduated from Geisel School Of Medicine At Dartmouth in 1985.
Is Stephen Gross MD registered in PECOS?
Yes, as of May 11, 2023 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a Medicare 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.
How much is a visit to Stephen Gross MD?
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.
What are some of the services provided by Stephen Gross MD?
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.
Is Stephen Gross MD affiliated to any hospitals?
The practitioner is affiliated to the following hospitals: WESTERLY HOSPITAL. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
How do I update my NPI information?
The NPI record of Stephen Gross MD 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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