DENISE M LEDOUX PA-C
NPI 1245385442
Physician Assistant - Medical in Marietta, GA


Quality Rating: 92.93 out of 100 score

NPI Status: Active since January 25, 2007

Contact Information

55 WHITCHER ST NE
SUITE 350
MARIETTA, GA
ZIP 30060
Phone: (770) 424-6893
Fax: (678) 819-0357

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  • Individual
  • Female
  • Physician Assistant
  • Medical
  • Accepts Insurance
  • PECOS Enrolled

About DENISE LEDOUX

This page provides the complete NPI Profile along with additional information for Denise Ledoux, a primary care provider established in Marietta, Georgia with a medical specialization in Physician Assistant, focusing in medical . The healthcare provider is registered in the NPI registry with number 1245385442 assigned on January 2007. The practitioner's primary taxonomy code is 363AM0700X with license number 001927 (GA). The provider is registered as an individual and her NPI record was last updated 14 years ago.

NPI
1245385442
Provider Name
DENISE M LEDOUX PA-C
Gender
Female
Entity Type
Individual
Location Address
55 WHITCHER ST NE SUITE 350 MARIETTA, GA 30060
Location Phone
(770) 424-6893
Location Fax
(678) 819-0357
Mailing Address
55 WHITCHER ST NE SUITE 350 MARIETTA, GA 30060
Mailing Phone
(770) 424-6893
Mailing Fax
(678) 819-0357
Is Sole Proprietor?
No
Enumeration Date
01-25-2007
Last Update Date
06-27-2012
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A primary care provider (PCP) like Denise Ledoux 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

Physician Assistant Medical

Taxonomy Code
363AM0700X
Type
Physician Assistants & Advanced Practice Nursing Providers
License No.
001927
License State
GA

Insurance Plans Accepted

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

  • SoloCare Bronze EPO $8500 DED HSA 10004 - EPO
  • SoloCare Exp Bronze EPO $9500 DED 10015 - EPO
  • SoloCare Gold EPO $1500 DED 10010 - EPO
  • SoloCare Silver EPO $5000 DED 10014 - EPO
  • SoloCare Silver EPO $6500 DED 10013 - EPO
  • SoloCare Standard Exp Bronze EPO $7500 DED 10008 - EPO
  • SoloCare Standard Gold EPO $2000 DED 10006 - EPO
  • SoloCare Standard Platinum EPO $0 DED 10005 - EPO
  • SoloCare Standard Silver EPO $6000 DED 10007 - EPO

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

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 Identifier Issuer
003109728BMEDICAID (05)GA 
003109728CMEDICAID (05)GA 
202I972434MEDICARE UPIN (02)GA 
S26367MEDICARE UPIN (02) 
003109728AMEDICAID (05)GA 

Medicare Participation & PECOS Enrollment Status

Denise Ledoux 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

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 92.93, 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: 92.93 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: 80.38

    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: 100

    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: 40

    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.

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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 1245385442, we treat the final digit (2) 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 68. The final step is to find the difference between that total and the next multiple of ten (70 - 68 = 2).

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
1
Doubled → 2
Pos 2
2
Unchanged
Pos 3
4
Doubled → 8
Pos 4
5
Unchanged
Pos 5
3
Doubled → 6
Pos 6
8
Unchanged
Pos 7
5
Doubled → 10 → 1 + 0
Pos 8
4
Unchanged
Pos 9
4
Doubled → 8
Check
2
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 4 → 8 3 → 6 5 → 10 → 1 4 → 8

Step 2: Add all digits plus the NPI constant

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

2 + 2 + 8 + 5 + 6 + 8 + 1 + 0 + 4 + 8 + 24 = 68

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

The next multiple of ten after 68 is 70. The difference is the calculated check digit.

70 - 68 = 2
This NPI is valid
The calculated check digit is 2, which matches the last digit of 1245385442.

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MARIETTA, GA 30060
Physician Assistant (Medical)
55 WHITCHER ST NE, SUITE 350
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Nurse Practitioner (Acute Care)
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Physician Assistant (Medical)
55 WHITCHER ST NE, SUITE 350
MARIETTA, GA 30060
Internal Medicine (Infectious Disease)
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MARIETTA, GA 30060
Internal Medicine (Endocrinology, Diabetes & Metabolism)
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Internal Medicine (Pulmonary Disease)
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Internal Medicine (Pulmonary Disease)
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Internal Medicine (Pulmonary Disease)
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Dietitian, Registered (Nutrition, Renal)
55 WHITCHER ST NE, SUITE 460
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Internal Medicine (Pulmonary Disease)
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MARIETTA, GA 30060
Pharmacist
55 WHITCHER ST NE
MARIETTA, GA 30060
Physician Assistant
55 WHITCHER ST NE, SUITE 350
MARIETTA, GA 30060
Dentist (Oral and Maxillofacial Surgery)
55 WHITCHER ST NE, SUITE 140
MARIETTA, GA 30060
Clinical Nurse Specialist (Adult Health)
55 WHITCHER ST NE, SUITE 350
MARIETTA, GA 30060
Oral & Maxillofacial Surgery
55 WHITCHER ST NE, SUITE 140
MARIETTA, GA 30060
Physician Assistant
55 WHITCHER ST NE, SUITE 350
MARIETTA, GA 30060
Nurse Practitioner (Adult Health)
55 WHITCHER ST NE, SUITE 350
MARIETTA, GA 30060

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1245385442, enumerated as an "individual" on January 25, 2007.

The provider is located at 55 WHITCHER ST NE SUITE 350 MARIETTA, GA 30060 and the phone number is (770) 424-6893.

Physician Assistant with taxonomy code 363AM0700X and a focus in Medical.

The provider might be accepting Accepts: Alliant Health Plans, Inc., Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.