DR. GEORGE M. VERGHESE M.D.
NPI 1235176371
Internal Medicine - Pulmonary Disease in Charlottesville, VA

NPI Status: Active since May 31, 2006

Contact Information

5 HOSPITAL DR
CHARLOTTESVILLE, VA
ZIP 22908
Phone: (434) 924-5219
Fax: (434) 924-9682

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

Individual
Male
Years of Experience 33
Internal Medicine
Pulmonary Disease
May Accept Medicare Approved Payment
PECOS Enrolled
Medicare Quality Reporting

About GEORGE VERGHESE

This page provides the complete NPI Profile along with additional information for George Verghese, an internist established in Charlottesville, Virginia with a medical specialization in Internal Medicine, focusing in pulmonary disease and more than 33 years of experience. He graduated from Duke University School Of Medicine in 1993. The healthcare provider is registered in the NPI registry with number 1235176371 assigned on May 2006. The practitioner's primary taxonomy code is 207RP1001X with license number 0101233286 (VA). The provider is registered as an individual and his NPI record was last updated 13 years ago.

NPI: 1235176371
Provider Name: DR. GEORGE M. VERGHESE M.D.
Gender: Male
Entity Type: Individual
Location Address: 5 HOSPITAL DR CHARLOTTESVILLE, VA 22908
Location Phone: (434) 924-5219
Location Fax: (434) 924-9682
Mailing Address: PO BOX 9007 CHARLOTTESVILLE, VA 22906
Medical School Name: DUKE UNIVERSITY SCHOOL OF MEDICINE
Graduation Year: 1993
Is Sole Proprietor?: No
Enumeration Date: 05-31-2006
Last Update Date: 01-17-2013
Code Navigator

An internist like George Verghese is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, 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: Internal Medicine Pulmonary Disease
Taxonomy Code: 207RP1001X
Type: Allopathic & Osteopathic Physicians
License No.: 0101233286
License State: VA
Taxonomy Description: An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.

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	207RC0200X	Allopathic & Osteopathic Physicians	Internal Medicine Critical Care Medicine	A54405 (CA)
2	207RC0200X	Allopathic & Osteopathic Physicians	Internal Medicine Critical Care Medicine	0101233286 (VA)
3	207RP1001X	Allopathic & Osteopathic Physicians	Internal Medicine Pulmonary Disease	A54405 (CA)

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State
290000297	MEDICAID (05)	VA
290000297	MEDICARE PIN (08)	VA
G46363	MEDICARE UPIN (02)	VA

Medicare Participation & PECOS Enrollment Status

George Verghese is registered with Medicare but maybe doesn't accept claims assignment. If you are a Medicare beneficiary call and confirm with the provider before seeking any services.

George Verghese 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: 4789692658
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: I20060404000407
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? Maybe
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)
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable (HCPCS:A7003)
2 DME suppliers used 13 Medicare Claims 26 Services Paid
DME-Other DME (DE000N)
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable (HCPCS:A7005)
4 DME suppliers used 18 Medicare Claims 18 Services Paid
DME-Other DME (DE001N)
Tubing used with positive airway pressure device (HCPCS:A7037)
2 DME suppliers used 13 Medicare Claims 13 Services Paid
DME-Other DME (DE001N)
Filter, disposable, used with positive airway pressure device (HCPCS:A7038)
4 DME suppliers used 16 Medicare Claims 96 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)
6 DME suppliers used 150 Medicare Claims 157 Services Paid
DME-Other DME (DE000N)
Nebulizer, with compressor (HCPCS:E0570)
2 DME suppliers used 60 Medicare Claims 60 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)
9 DME suppliers used 399 Medicare Claims 419 Services Paid
DME-Oxygen and Supplies (DC002N)
Portable oxygen concentrator, rental (HCPCS:E1392)
2 DME suppliers used 124 Medicare Claims 124 Services Paid
DME-Oxygen and Supplies (DC000N)
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing (HCPCS:K0738)
2 DME suppliers used 57 Medicare Claims 57 Services Paid
DME-Other DME (DE000N)
Pharmacy dispensing fee for inhalation drug(s); per 30 days (HCPCS:Q0513)
22 DME suppliers used 196 Medicare Claims 196 Services Paid
DME-Other DME (DE000N)
Pharmacy dispensing fee for inhalation drug(s); per 90 days (HCPCS:Q0514)
5 DME suppliers used 11 Medicare Claims 11 Services Paid

Drugs Administered Through DME

DME-Drugs Administered Through DME (DG006N)
Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms (HCPCS:J7605)
7 DME suppliers used 86 Medicare Claims 5160 Services Paid
DME-Drugs Administered Through DME (DG006N)
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg (HCPCS:J7613)
14 DME suppliers used 83 Medicare Claims 18543 Services Paid
DME-Drugs Administered Through DME (DG006N)
Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 0.5 mg (HCPCS:J7614)
4 DME suppliers used 16 Medicare Claims 4455 Services Paid
DME-Drugs Administered Through DME (DG006N)
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme (HCPCS:J7620)
14 DME suppliers used 66 Medicare Claims 8160 Services Paid
DME-Drugs Administered Through DME (DG000N)
Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg (HCPCS:J7626)
8 DME suppliers used 100 Medicare Claims 5850 Services Paid
DME-Drugs Administered Through DME (DG006N)
Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram (HCPCS:J7644)
3 DME suppliers used 16 Medicare Claims 742 Services Paid
DME-Drugs Administered Through DME (DG006N)
Revefenacin inhalation solution, fda-approved final product, non-compounded, administered through dme, 1 microgram (HCPCS:J7677)
2 DME suppliers used 14 Medicare Claims 73500 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
Critical care, first 30-74 minutes
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
Follow-up hospital inpatient care per day, typically 25 minutes
Follow-up hospital inpatient care per day, typically 35 minutes
Influenza vaccine split virus, preservative free
Initial hospital inpatient care per day, typically 50 minutes
Initial hospital inpatient care per day, typically 70 minutes
Insertion of non-tunneled central venous tube for infusion (5 years or older)
New patient office or other outpatient visit, 30-44 minutes
New patient office or other outpatient visit, 45-59 minutes
New patient office or other outpatient visit, 60-74 minutes
Smoking and tobacco use intensive counseling, 4-10 minutes
Telephone medical discussion with physician, 11-20 minutes
Test to determine lung volumes using sensors
Test to examine how well the lungs exchange gases
Test to measure expiratory airflow and volume
Test to measure expiratory airflow and volume changes before and after medication administration

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 22908 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99204

Average New Patient Price $129.04
Minimum New Patient Price $56.19
Maximum New Patient Price $170.3

Average New Patient Copayment $32.26
Minimum New Patient Copayment $14.04
Maximum New Patient Copayment $42.57

Established Patients Visit Costs *

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

Average Established Patient Price $99.13
Minimum Established Patient Price $18.07
Maximum Established Patient Price $138.91

Average Established Patient Copayment $24.78
Minimum Established Patient Copayment $4.51
Maximum Established Patient Copayment $34.72

* 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
Chronic Care and Preventative Care Management for Empaneled Patients	Yes	N/A
Proactively manage chronic and preventive care for empaneled patients that could include one or more of the following: • Provide patients annually with an opportunity for development and/or adjustment of an individualized plan of care as appropriate to age and health status, including health risk appraisal; gender, age and condition-specific preventive care services; and plan of care for chronic conditions; • Use condition-specific pathways for care of chronic conditions (e.g., hypertension, diabetes, depression, asthma and heart failure) with evidence-based protocols to guide treatment to target; such as a CDC-recognized diabetes prevention program; • Use pre-visit planning to optimize preventive care and team management of patients with chronic conditions; • Use panel support tools (registry functionality) to identify services due; • Use predictive analytical models to predict risk, onset and progression of chronic diseases; or • Use reminders and outreach (e.g., phone calls, emails, postcards, patient portals and community health workers where available) to alert and educate patients about services due; and/or routine medication reconciliation.
Colorectal Cancer Screening	45%	411
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
Diabetes: Eye Exam	44%	94
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
e-Prescribing	88%	1636
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Health Information Exchange	71%	113
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 at least one transition of care or referral.
Immunization Registry Reporting	Yes	N/A
The MIPS eligible clinician is in active engagement with a public health agency to submit immunization data.
Implementation of medication management practice improvements	Yes	N/A
Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/or Conduct periodic, structured medication reviews.
Measurement and Improvement at the Practice and Panel Level	Yes	N/A
Measure and improve quality at the practice and panel level, such as the American Board of Orthopaedic Surgery (ABOS) Physician Scorecards, that could include one or more of the following: • Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice level and at the level of the care team or MIPS eligible clinician or group (panel); and/or • Use relevant data sources to create benchmarks and goals for performance at the practice level and panel level.
Medication Reconciliation	99%	468
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.
Patient-Specific Education	86%	680
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.
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan	94%	664
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
Provide Patient Access	73%	680
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	36%	680
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 decision support and standardized treatment protocols	Yes	N/A
Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs.

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. George Verghese is affiliated with the following medical facilities:

Hospital Name	Address	Phone	Hospital Type	Overall Rating
UNIVERSITY OF VIRGINIA MEDICAL CENTER	1215 LEE STREET CHARLOTTESVILLE, VA 22908	(434) 924-0000	Acute Care Hospitals
AUGUSTA HEALTH	78 MEDICAL CENTER DRIVE FISHERSVILLE, VA 22939	(540) 332-4000	Acute Care Hospitals

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 1235176371, we treat the final digit (1) 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 59. The final step is to find the difference between that total and the next multiple of ten (60 - 59 = 1).

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 → 6

Pos 4

Unchanged

Pos 5

Doubled → 2

Pos 6

Unchanged

Pos 7

Doubled → 12 → 1 + 2

Pos 8

Unchanged

Pos 9

Doubled → 14 → 1 + 4

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 3 → 6 1 → 2 6 → 12 → 3 7 → 14 → 5

Step 2: Add all digits plus the NPI constant

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

2 + 2 + 6 + 5 + 2 + 7 + 1 + 2 + 3 + 1 + 4 + 24 = 59

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

The next multiple of ten after 59 is 60. The difference is the calculated check digit.

60 - 59 = 1

This NPI is valid

The calculated check digit is 1, which matches the last digit of 1235176371.