DR. MARK ALLEN WALLINGFORD MD
NPI 1205919875
Internal Medicine in Maysville, KY
Active since October 24, 2006PECOS EnrolledAccepts Medicare Assignment
75/100
CMS Quality Rating
About Dr. Mark Allen Wallingford Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. MARK ALLEN WALLINGFORD MD (NPI 1205919875) is an individual internal medicine provider in Maysville, Kentucky, licensed in Kentucky (24430) and active in the NPI registry since October 2006. He is enrolled in Medicare PECOS, is affiliated with Meadowview Regional Medical Center, and is a graduate of University Of Kentucky College Of Medicine (1982).
NPPES Registry Identity
NPI1205919875
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameDR. MARK ALLEN WALLINGFORDCredential: MD
Location Address2009 OLD MAIN STREETMaysville, KY 41056
Mailing Address2009 Old Main StreetMaysville, KY 41056 · (606) 759-7615 · Fax (606) 759-7821
Phone(606) 759-7615
Fax(606) 759-7821
Sole ProprietorNo
Medical School CMSUniversity Of Kentucky College Of MedicineGraduated 1982
Enumeration DateOctober 24, 2006
Last NPPES UpdateJanuary 30, 2017
✔ NPI 1205919875 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses 2
★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in KY · 24430
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedPediatricsTaxonomy 208000000X · License 24430 (KY)
2009 OLD MAIN STREET, Maysville, KY 41056
Other Identifiers 3
Medicaid64244304KY
Medicare UPINC78288
Medicare PIN252901KY
Accepted Insurance
The full list of accepted plans is on the Insurance tab. Issuers include CareSource.Insurance ›
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
✔
Enrolled in Medicare and accepts Medicare assignment
Dr. Mark Allen Wallingford Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
PECOS PAC ID4587638721
PECOS Enrollment IDI20101015000896
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.
Areas of Expertise CMS Part B claims 11
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This 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.
805 services297 patients
Insertion of needle into vein for collection of blood sample 36415
This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
457 services253 patients
Injection of drug or substance under skin or into muscle 96372
This 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.
144 services22 patients
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg J3420
This 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.
143 services20 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
110 services110 patients
Administration of influenza virus vaccine G0008
The 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.
58 services58 patients
Hospital Affiliations CMS Care Compare 3
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Meadowview Regional Medical Center
Acute Care Hospitals · Maysville, KYOwnershipProprietary
CMS Certification Number180019
Location989 Medical Park DriveMaysville, KY 41056 · Mason County
Emergency services Birthing friendly
University Of Cincinnati Medical Center, LLC
Acute Care Hospitals · Cincinnati, OHOwnershipVoluntary non-profit - Private
CMS Certification Number360003
Location3188 Bellevue AvenueCincinnati, OH 45219 · Hamilton County
Emergency services Birthing friendly
Adams County Regional Medical Center
Critical Access Hospitals · Seaman, OHOwnershipGovernment - Local
CMS Certification Number361326
Location230 Medical Center DriveSeaman, OH 45679 · Adams County
Emergency services
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 41056 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
New Patient
$122.77 typical visit price
range $52.76 – $162.27
Typical copayment $30.69 (range $13.19 – $40.56)
Most-billed visit code 99204
Established Patient
$93.94 typical visit price
range $16.53 – $131.99
Typical copayment $23.48 (range $4.13 – $32.99)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
75/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practiceReported Quality Measures
Appropriate Treatment for Children with Upper Respiratory Infection (URI)
Percentage of children 3 months-18 years of age who were diagnosed with upper respiratory infection (URI) and were not dispensed an antibiotic prescription on or three days after the episode
86%37 patients
Breast Cancer Screening
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
73%468 patients4/55-star benchmark: 92%
Cervical Cancer Screening
Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria: - Women age 21-64 who had cervical cytology performed every 3 years - Women age 30-64 who had cervical cytology/human papillomavirus (HPV)…
9%399 patients
Colorectal Cancer Screening
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
55%969 patients3/55-star benchmark: 85%
Diabetes: Eye Exam
Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period
30%301 patients2/55-star benchmark: 100%
Diabetes: Foot Exam
The percentage of patients 18-75 years of age with diabetes (type 1 and type 2) who received a foot exam (visual inspection and sensory exam with mono filament and a pulse exam) during the measurement year
76%301 patients4/55-star benchmark: 98%
Diabetes: Medical Attention for Nephropathy
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
97%301 patients4/55-star benchmark: 99%
Documentation of Current Medications in the Medical Record
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.
100%3,931 patients5/55-star benchmark: 100%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
98%13,019 patients4/55-star benchmark: 99%
Health Information Exchange
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for…
54%171 patients3/55-star benchmark: 88%
Medication Reconciliation
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.
87%83 patients2/55-star benchmark: 100%
Patient-Specific Education
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.
88%1,833 patients4/55-star benchmark: 97%
Pneumococcal Vaccination Status for Older Adults
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
59%632 patients3/55-star benchmark: 90%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
22%1,692 patients1/55-star benchmark: 97%
Preventive Care and Screening: Influenza Immunization
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
39%1,321 patients2/55-star benchmark: 88%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
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
Patients screenedForUse: 98% · 1,445 patients
Patients tobacco: 88% · 1,445 patients
26%226 patients2/55-star benchmark: 98%
Provide Patient Access
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…
95%1,833 patients4/55-star benchmark: 100%
Secure Messaging
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…
32%1,833 patients2/55-star benchmark: 89%
Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period: - Adults aged >= 21 years who were previously diagnosed with or currently have an active…
80%538 patients4/55-star benchmark: 89%
Use of High-Risk Medications in the Elderly
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication.
Lower rates are better for this measure.
Patients 2+: 1% · 632 patients
5%632 patients4/55-star benchmark: 100%
View, Download, or Transmit (VDT)
At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period.
19%1,833 patients
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
Percentage of patients 3-17 years of age who had an outpatient visit with a Primary Care Physician (PCP) or Obstetrician/Gynecologist (OB/GYN) and who had evidence of the following during the measurement period. Three rates are reported.
Patients physicalActivity: 1% · 90 patients
100%90 patients
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.
Referred Medical Equipment & Supplies CMS DME claims 20
Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
11 suppliers72 claims178 services$6.22 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
9 suppliers25 claims43 services$1.13 avg. paid by Medicare
Tubing with integrated heating element for use with positive airway pressure device A4604
DME-Other DME · category DE001N
3 suppliers17 claims17 services$33.10 avg. paid by Medicare
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034
DME-Other DME · category DE001N
2 suppliers13 claims13 services$48.08 avg. paid by Medicare
Headgear used with positive airway pressure device A7035
DME-Other DME · category DE001N
3 suppliers18 claims18 services$19.43 avg. paid by Medicare
Filter, disposable, used with positive airway pressure device A7038
DME-Other DME · category DE001N
4 suppliers17 claims79 services$2.38 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Mark Wallingford's NPI number?
The NPI number for Mark Wallingford is 1205919875. It was assigned to this individual provider in the NPPES registry on October 24, 2006.
Where is Mark Wallingford located?
Mark Wallingford practices at 2009 Old Main Street, Maysville, KY 41056. The listed phone number is (606) 759-7615.
What is Mark Wallingford's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Mark Wallingford enrolled in Medicare?
Yes. Mark Wallingford is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
What insurance does Mark Wallingford accept?
Health plans from CareSource list Mark Wallingford as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
Is Mark Wallingford affiliated with any hospitals?
According to CMS data, Mark Wallingford is affiliated with Meadowview Regional Medical Center, University Of Cincinnati Medical Center, LLC and Adams County Regional Medical Center.
When was this NPI record last updated?
The NPPES record for Mark Wallingford was last updated on January 30, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dr. Mark Allen Wallingford, MD · NPI 1205919875
Internal Medicine physician in Maysville, Kentucky. Individual provider, active in the CMS NPPES registry since October 24, 2006.
## Identity
- **NPI:** 1205919875 (Entity type: Individual)
- **Enumerated:** October 24, 2006
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **State license:** 24430 (Kentucky)
- **Sole proprietor:** No
## Practice location
- **Address:** 2009 OLD MAIN STREET, Maysville, KY 41056
- **Phone:** (606) 759-7615 · **Fax:** (606) 759-7821
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Medical school:** University Of Kentucky College Of Medicine, class of 1982
## Record status
- **NPPES last updated:** January 30, 2017
- **Other identifiers:** Medicaid 64244304 (KY); Medicare UPIN C78288; Medicare PIN 252901 (KY)
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Source: [NPI Profile](https://npiprofile.com/npi/1205919875) · Data from the CMS NPPES public registry.