DR. GEORGE CARLTON GILBERT M.D.
NPI 1215021100
Family Medicine in Peoria, IL

NPI Status: Active since October 03, 2006

Contact Information

3525 N UNIVERSITY ST
PEORIA, IL
ZIP 61604
Phone: (309) 886-9172
Fax: (309) 509-4045

NPI Profile Information
Primary Taxonomy
Secondary Taxonomies
Medicare Participation & PECOS Status
Areas of Expertise
Durable Medical Equipment
Physician Visit Costs
Quality Reporting
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Male
Family Medicine
PECOS Enrolled
Medicare Quality Reporting

About GEORGE GILBERT

This page provides the complete NPI Profile along with additional information for George Gilbert, a primary care provider established in Peoria, Illinois with a medical specialization in Family Medicine. The healthcare provider is registered in the NPI registry with number 1215021100 assigned on October 2006. The practitioner's primary taxonomy code is 207Q00000X with license number 036077426 (IL). The provider is registered as an individual and his NPI record was last updated 2 years ago.

NPI: 1215021100
Provider Name: DR. GEORGE CARLTON GILBERT M.D.
Gender: Male
Entity Type: Individual
Location Address: 3525 N UNIVERSITY ST PEORIA, IL 61604
Location Phone: (309) 886-9172
Location Fax: (309) 509-4045
Mailing Address: PO BOX 9727 PEORIA, IL 61612
Mailing Phone: (309) 886-9172
Mailing Fax: (309) 509-4045
Is Sole Proprietor?: Yes
Enumeration Date: 10-03-2006
Last Update Date: 12-22-2023
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A primary care provider (PCP) like George Gilbert sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, 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: Family Medicine
Taxonomy Code: 207Q00000X
Type: Allopathic & Osteopathic Physicians
License No.: 036077426
License State: IL
Taxonomy Description: Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No.	Taxonomy Code	Type	Classification / Specialization	License No. (State)
1	207QA0401X	Allopathic & Osteopathic Physicians	Family Medicine Addiction Medicine	036077426 (IL)

Medicare Participation & PECOS Enrollment Status

George Gilbert 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
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

Provider Referred Orders for Durable Medical Equipment, Devices & Supplies

The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.

Durable Medical Equipment

DME-Other DME (DE017N)
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (HCPCS:A4253)
16 DME suppliers used 65 Medicare Claims 160 Services Paid
DME-Medical/Surgical Supplies (DA000N)
Lancets, per box of 100 (HCPCS:A4259)
8 DME suppliers used 18 Medicare Claims 24 Services Paid
DME-Other DME (DE001N)
Tubing with integrated heating element for use with positive airway pressure device (HCPCS:A4604)
7 DME suppliers used 25 Medicare Claims 25 Services Paid
DME-Other DME (DE001N)
Pillow for use on nasal cannula type interface, replacement only, pair (HCPCS:A7033)
6 DME suppliers used 19 Medicare Claims 100 Services Paid
DME-Other DME (DE001N)
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap (HCPCS:A7034)
5 DME suppliers used 28 Medicare Claims 28 Services Paid
DME-Other DME (DE001N)
Headgear used with positive airway pressure device (HCPCS:A7035)
7 DME suppliers used 25 Medicare Claims 25 Services Paid
DME-Other DME (DE001N)
Filter, disposable, used with positive airway pressure device (HCPCS:A7038)
7 DME suppliers used 38 Medicare Claims 194 Services Paid
DME-Other DME (DE001N)
Water chamber for humidifier, used with positive airway pressure device, replacement, each (HCPCS:A7046)
6 DME suppliers used 16 Medicare Claims 16 Services Paid
DME-Oxygen and Supplies (DC000N)
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing (HCPCS:E0431)
2 DME suppliers used 15 Medicare Claims 15 Services Paid
DME-Other DME (DE001N)
Humidifier, heated, used with positive airway pressure device (HCPCS:E0562)
2 DME suppliers used 16 Medicare Claims 16 Services Paid
DME-Other DME (DE001N)
Continuous positive airway pressure (cpap) device (HCPCS:E0601)
4 DME suppliers used 30 Medicare Claims 30 Services Paid
DME-Oxygen and Supplies (DC002N)
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)
2 DME suppliers used 15 Medicare Claims 15 Services Paid
DME-Other DME (DE017N)
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service (HCPCS:K0553)
3 DME suppliers used 17 Medicare Claims 17 Services Paid
DME-Other DME (DE000N)
Pharmacy dispensing fee for inhalation drug(s); per 30 days (HCPCS:Q0513)
6 DME suppliers used 12 Medicare Claims 12 Services Paid

Orthotic Devices

DME-Orthotic Devices (DF008N)
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each (HCPCS:A4351)
3 DME suppliers used 14 Medicare Claims 1980 Services Paid

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 influenza virus vaccine
Assessment of emotional or behavioral problems
Automated urinalysis test
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
Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage
Testing for presence of drug, read by direct observation

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 61604 ZIP code area.

New Patients Visit Costs *

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

Average New Patient Price $85.71
Minimum New Patient Price $54.8
Maximum New Patient Price $168.44

Average New Patient Copayment $21.42
Minimum New Patient Copayment $13.7
Maximum New Patient Copayment $42.11

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

Average Established Patient Price $97.25
Minimum Established Patient Price $17.16
Maximum Established Patient Price $136.56

Average Established Patient Copayment $24.31
Minimum Established Patient Copayment $4.29
Maximum Established Patient Copayment $34.14

* 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.

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
Breast Cancer Screening	19%	242
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
Colorectal Cancer Screening	24%	525
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
Consultation of the Prescription Drug Monitoring Program	Yes	N/A
Clinicians would attest to reviewing the patients’ history of controlled substance prescription using state prescription drug monitoring program (PDMP) data prior to the issuance of a Controlled Substance Schedule II (CSII) opioid prescription lasting longer than 3 days. For the transition year, clinicians would attest to 60 percent review of applicable patient’s history. For the Quality Payment Program Year 2 and future years, clinicians would attest to 75 percent review of applicable patient’s history performance.
Depression screening	Yes	N/A
Depression screening and follow-up plan: Regular engagement of MIPS eligible clinicians or groups in integrated prevention and treatment interventions, including depression screening and follow-up plan (refer to NQF #0418) for patients with co-occurring conditions of behavioral or mental health conditions.
Diabetes: Eye Exam	8%	168
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
Diabetes: Foot Exam	5%	167
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
Diabetes: Medical Attention for Nephropathy	67%	168
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
Documentation of Current Medications in the Medical Record	88%	4462
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
e-Prescribing	94%	12171
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Falls: Screening for Future Fall Risk	0%	459
Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period
Immunization Registry Reporting	Yes	N/A
The MIPS eligible clinician is in active engagement with a public health agency to submit immunization data.
MDD prevention and treatment interventions	Yes	N/A
Major depressive disorder: Regular engagement of MIPS eligible clinicians or groups in integrated prevention and treatment interventions, including suicide risk assessment (refer to NQF #0104) for mental health patients with co-occurring conditions of behavioral or mental health conditions.
Patient-Specific Education	99%	1263
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	15%	459
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan	27%	1237
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 twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2
Preventive Care and Screening: Influenza Immunization	22%	958
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: Screening for Depression and Follow-Up Plan	82%	704
Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen
Promote Use of Patient-Reported Outcome Tools	Yes	N/A
Demonstrate performance of activities for employing patient-reported outcome (PRO) tools and corresponding collection of PRO data such as the use of PQH-2 or PHQ-9, PROMIS instruments, patient reported Wound-Quality of Life (QoL), patient reported Wound Outcome, and patient reported Nutritional Screening.
Provide Patient Access	68%	1263
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	0%	1263
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.
Use of High-Risk Medications in the Elderly	12% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better.	459
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. 2) Percentage of patients who were ordered at least two of the same high-risk medication

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 1215021100, we treat the final digit (0) 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 40. The final step is to find the difference between that total and the next multiple of ten (40 - 40 = 0).

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.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 2

Pos 4

Unchanged

Pos 5

Doubled → 0

Pos 6

Unchanged

Pos 7

Doubled → 2

Pos 8

Unchanged

Pos 9

Doubled → 0

Check

Target digit

Regular digit Doubled digit Check digit

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.

1 → 2 1 → 2 0 → 0 1 → 2 0 → 0

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 2 + 2 + 5 + 0 + 2 + 2 + 1 + 0 + 24 = 40

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 40 is 40. The difference is the calculated check digit.

40 - 40 = 0

This NPI is valid

The calculated check digit is 0, which matches the last digit of 1215021100.