SAMIR C GURU D.O.
NPI 1215923396
Orthopaedic Surgery in Mount Dora, FL

Medicare Participation & PECOS Enrollment Status

Samir Guru 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.

Samir Guru 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: 9931138328

  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: I20050805000552

  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

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 (DE000N)

  Walker, folding, wheeled, adjustable or fixed height (HCPCS:E0143)

  2 DME suppliers used 11 Medicare Claims 11 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.

Aspiration and/or injection of fluid from large joint

This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.

This service was performed 1,202 times for 541 patients

Aspiration and/or injection of fluid from medium joint

This procedure involves a needle being inserted into a medium-sized joint, such as a knee or shoulder, to remove (aspirate) excess fluid. Sometimes, medication may also be injected into the joint to reduce inflammation and pain.

This service was performed 30 times for 28 patients

Aspiration and/or injection of fluid from small joint

This procedure involves inserting a thin needle into a small joint to remove (aspirate) or inject fluid. It can help diagnose conditions, relieve discomfort, or administer medication directly into the joint. It's generally safe with minimal discomfort.

This service was performed 14 times for 14 patients

Established patient office or other outpatient visit, 10-19 minutes

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

This service was performed 50 times for 28 patients

Established patient office or other outpatient visit, 20-29 minutes

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

This service was performed 886 times for 577 patients

Established patient office or other outpatient visit, 30-39 minutes

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.

This service was performed 489 times for 385 patients

Hip replacement

A hip replacement is a surgical procedure where a worn-out or damaged hip joint is replaced with an artificial one. This procedure can greatly reduce pain and improve mobility. It's often recommended when other treatments like physical therapy or medications fail to alleviate symptoms.

This service was performed for 67 patients

Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose

Hyaluronan or Euflexxa is a substance similar to a natural substance in your joints. It's injected into the joint space to treat pain from osteoarthritis, especially in the knee. It helps to lubricate the joint, reducing pain and improving mobility.

This service was performed 565 times for 128 patients

Initial hospital inpatient care per day, typically 30 minutes

Initial hospital inpatient care refers to the first day of your stay in the hospital. This service typically includes a 30-minute check-up with a healthcare professional. They'll assess your health, discuss your condition, and plan your treatment. It's part of ensuring you receive the best possible care.

This service was performed 39 times for 38 patients

Initial hospital inpatient care per day, typically 50 minutes

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

This service was performed 13 times for 13 patients

Injection into tendon or ligament

An injection into a tendon or ligament involves placing medication directly into these areas to help reduce inflammation and pain. It's often used for conditions like arthritis or tendonitis. The procedure is quick and usually involves a local anesthetic.

This service was performed 45 times for 40 patients

Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg

This injection contains two medications, betamethasone acetate and betamethasone sodium phosphate. It is used to reduce inflammation and pain. It's given by a healthcare professional, often directly into the area causing discomfort.

This service was performed 123 times for 89 patients

Injection, methylprednisolone acetate, 80 mg

Methylprednisolone acetate is a strong anti-inflammatory medication. It is often given as an 80 mg injection to reduce inflammation and pain. It's commonly used for conditions like arthritis, allergic disorders, or other inflammatory diseases.

This service was performed 628 times for 373 patients

Injection, triamcinolone acetonide, not otherwise specified, 10 mg

Triamcinolone acetonide is a medication used to reduce inflammation in the body. It's given as a 10 mg injection for conditions like allergies, arthritis, or skin problems. The injection helps to decrease swelling, redness, and itching.

This service was performed 1,998 times for 225 patients

Knee replacement

A knee replacement is a surgical procedure where a damaged or diseased knee joint is replaced with an artificial one. This can relieve pain and improve mobility. The procedure involves removing damaged parts of the knee and inserting a prosthetic joint. Recovery may take several weeks.

This service was performed for 137 patients

Lower limb (leg) arthroscopy (minimally invasive joint repair)

Lower limb arthroscopy is a minimally invasive procedure that allows doctors to examine and repair issues in your leg joints. It involves making small incisions through which a tiny camera and instruments are inserted. This technique can help diagnose and treat various joint problems with less pain and quicker recovery time.

This service was performed for 76 patients

New patient office or other outpatient visit, 30-44 minutes

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

This service was performed 159 times for 159 patients

New patient office or other outpatient visit, 45-59 minutes

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

This service was performed 267 times for 267 patients

Partial removal of collar bone at shoulder using an endoscope

This procedure involves the partial removal of the collar bone at the shoulder using an endoscope, a tool with a light and camera. It's done to relieve pain or improve shoulder movement. The surgeon makes small incisions, then uses the endoscope to guide their work.

This service was performed 30 times for 30 patients

Removal of both knee cartilages using an endoscope

This procedure, also known as bilateral knee arthroscopy, involves using a small camera (endoscope) to view and remove damaged cartilage from both knees. It's a minimally invasive surgery aimed at relieving pain and improving mobility.

This service was performed 18 times for 18 patients

Removal of knee cartilage using an endoscope

This procedure, known as arthroscopic knee surgery, involves using a small camera (endoscope) to view the inside of your knee. Small instruments are used to remove damaged cartilage. This can help alleviate pain and improve knee function.

This service was performed 30 times for 30 patients

Repair of shoulder rotator cuff using an endoscope

This procedure, known as arthroscopic rotator cuff repair, helps fix tears in the shoulder's rotator cuff. An endoscope, a small camera, is used to view the shoulder inside. Using small tools, the surgeon repairs the torn tissue. This minimally invasive approach often leads to a quicker recovery.

This service was performed 21 times for 20 patients

Replacement of knee joint, both sides of knee

A bilateral knee joint replacement is a procedure where the damaged parts of both your knee joints are replaced with artificial parts. It aims to relieve pain and improve mobility. The process involves a surgical operation under anesthesia.

This service was performed 58 times for 53 patients

Replacement of thigh bone and hip joint with prosthesis

This procedure, known as hip arthroplasty, involves replacing your damaged thigh bone and hip joint with artificial parts, called a prosthesis. It helps relieve pain, improve mobility, and enhance your quality of life.

This service was performed 38 times for 36 patients

Shaving of part of shoulder bone and repair of ligament using an endoscope

This procedure involves using a tiny camera, called an endoscope, to view and repair a damaged shoulder ligament. Simultaneously, a small portion of the shoulder bone is shaved to alleviate discomfort and improve movement. It's a minimally invasive technique that aids in a quicker recovery.

This service was performed 27 times for 27 patients

Treatment of upper end of broken thigh bone with placement of stabilizing device or prosthetic replacement

This procedure involves treating a fracture at the top of your thigh bone. A stabilizing device or prosthetic replacement is placed to aid in healing. This helps restore mobility and function while reducing pain. The treatment aims for a quick and safe recovery.

This service was performed 13 times for 13 patients

Upper limb (arm) arthroscopy (minimally invasive joint repair)

Upper limb arthroscopy is a minimally invasive procedure used to examine and treat issues within your arm's joints. A small camera, called an arthroscope, is inserted through a tiny incision, providing a clear view of the joint. This method often results in less pain and faster recovery compared to open surgery.

This service was performed for 35 patients

X-ray of ankle, minimum of 3 views

An ankle X-ray is a quick, painless imaging test. It involves capturing at least three different images or 'views' of your ankle using small amounts of radiation. These images help identify any abnormalities or injuries, such as fractures or arthritis.

This service was performed 16 times for 14 patients

X-ray of both hips, minimum of 5 views

An X-ray of both hips with a minimum of 5 views is a non-invasive imaging test. It uses a small amount of radiation to produce images of the hip joints from different angles. This aids in diagnosing conditions such as fractures, arthritis, or other hip abnormalities.

This service was performed 23 times for 22 patients

X-ray of elbow, 2 views

An elbow X-ray, 2 views, is a quick, painless imaging test. It uses a small amount of radiation to produce detailed images of your elbow from two different angles. This helps in diagnosing conditions like fractures, infection, or arthritis. It's a safe and effective way to monitor your elbow health.

This service was performed 24 times for 22 patients

X-ray of hand, 2 views

An X-ray of the hand, 2 views, is a non-invasive imaging test that uses a small amount of radiation to produce pictures of the bones in your hand. Two different angles are captured to provide a comprehensive view. This helps in diagnosing injuries or conditions affecting your hand.

This service was performed 94 times for 74 patients

X-ray of hip, 2-3 views

An X-ray of the hip with 2-3 views is a non-invasive imaging test. It uses a small amount of radiation to produce pictures of the hip joint. These images help in diagnosing conditions like fractures, arthritis, or other abnormalities. The process is quick and painless.

This service was performed 154 times for 139 patients

X-ray of knee, 3 views

An X-ray of the knee, 3 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of the knee from three different angles. This helps medical professionals to diagnose and monitor conditions like arthritis, fractures, or infections. The process is quick and painless.

This service was performed 449 times for 345 patients

X-ray of shoulder, minimum of 2 views

An X-ray of the shoulder, with a minimum of 2 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of your shoulder bones. This helps in diagnosing conditions like fractures, arthritis, or other abnormalities. The procedure is quick and painless.

This service was performed 204 times for 171 patients

X-ray of wrist, 2 views

An X-ray of the wrist, 2 views, is a diagnostic procedure where two different images of your wrist are taken using a small amount of radiation. This helps identify any abnormalities or injuries such as fractures or arthritis. It's a quick, non-invasive process.

This service was performed 32 times for 30 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $21.9 for a new patient copayment and $17.51 for an established patient copayment.

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 32757 ZIP code area.

* 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.

Overall MIPS Quality Performance

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 75, 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 Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS 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.

• Final Score: 75 out of 100

  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.
  
  

• Quality Score: N/A

  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 Score: N/A

  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 Score: N/A

  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 activities measure category compromises 15% providers final MPIS scores.
  
  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 Score: 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.

• Cost Score: 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.

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.

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

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. Samir Guru is affiliated with the following medical facilities:

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Frequently Asked Questions