MS. NICOLE MARIE SOUSA FNP-BC
NPI 1255744710
Nurse Practitioner - Family in Jupiter, FL

Medicare Participation & PECOS Enrollment Status

Nicole Sousa 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.

Nicole Sousa 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: 3779704895

  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: I20141014002204

  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

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.

Creation of muscle graft to trunk

The creation of a muscle graft to the trunk is a surgical procedure where healthy muscle tissue is moved from one part of the body to another. This helps to repair damaged areas, improve function, and enhance appearance. It's a common procedure in reconstructive surgery.

This service was performed 66 times for 32 patients

Drainage of abdominal abscess or infection

Drainage of an abdominal abscess or infection involves a procedure to remove pus that has collected in the abdomen due to an infection. This is typically done by inserting a thin tube through the skin into the abscess to drain the pus, helping to alleviate symptoms and promote healing.

This service was performed 32 times for 32 patients

Drainage of lymph fluid to abdominal cavity using an endoscope

This procedure involves using a thin, flexible tube (endoscope) to create a pathway for excess lymph fluid to drain into your abdominal cavity. This helps reduce swelling caused by fluid buildup. It's a minimally invasive procedure, often done under general anesthesia.

This service was performed 56 times for 55 patients

Exploration behind abdominal cavity

Exploration behind the abdominal cavity is a procedure to examine the area at the back of your abdomen. The goal is to identify any abnormalities or issues that may be causing discomfort or other health problems. This is done using imaging techniques or minimally invasive procedures.

This service was performed 81 times for 81 patients

Hernia repair (minimally invasive)

Hernia repair is a surgery to fix a hernia - a condition where an organ pushes through an opening in the muscle or tissue that holds it in place. Minimally invasive hernia repair involves small incisions, a tiny camera, and special surgical tools. This method often leads to quicker recovery, less pain, and reduced scarring compared to traditional surgery.

This service was performed for 1-10 patients

Placement of mesh to repair incisional or abdominal hernia

The procedure involves using a synthetic mesh to repair an abdominal or incisional hernia. A surgeon places the mesh over the area where the hernia occurred to provide support and prevent recurrence. It's a common, safe method for hernia repair.

This service was performed 29 times for 27 patients

Removal of gallbladder using an endoscope

This procedure, known as endoscopic gallbladder removal, involves a surgeon using a special tool called an endoscope to remove your gallbladder through small incisions. It's typically done to treat gallstones and related complications. It's a less invasive method, often leading to quicker recovery.

This service was performed 16 times for 16 patients

Removal of gallbladder with x-ray study of bile ducts using an endoscope

This procedure, known as an endoscopic retrograde cholangiopancreatography (ERCP), involves using a flexible camera (endoscope) to examine your bile ducts. If gallstones are found, your gallbladder may be removed in a separate procedure. This helps prevent future complications.

This service was performed 35 times for 34 patients

Repair of groin hernia using an endoscope

This procedure involves the use of an endoscope, a thin tube with a camera, to repair a hernia in the groin area. The surgeon makes small incisions, inserts the endoscope, and uses special tools to fix the hernia. This minimally invasive technique often results in quicker recovery times.

This service was performed 77 times for 77 patients

Repair of trapped incisional or abdominal hernia

Repair of a trapped incisional or abdominal hernia is a procedure to correct a bulge or protrusion of tissue or an organ through a weak spot in the abdominal wall. The surgery involves pushing the protruding tissue back into place and strengthening the abdominal wall to prevent future occurrences.

This service was performed 45 times for 44 patients

Repair of twisted or herniated small bowel

This procedure, known as small bowel repair, addresses issues like a twisted or herniated small intestine. The surgery involves making an incision to reach the affected area, untwisting or repairing the herniation, and ensuring proper blood flow. The goal is to restore normal function to your digestive tract.

This service was performed 15 times for 15 patients

Suture of multiple tears or holes in small bowel

This procedure involves repairing multiple tears or holes in your small intestine. Using special surgical thread, the surgeon stitches the damaged areas to promote healing and prevent complications. It's a common way to address intestinal injuries.

This service was performed 30 times for 29 patients

Suture of tear of hole in small bowel

A suture of a tear or hole in the small bowel is a surgical procedure to repair damage. The surgeon uses special threads to stitch the tear or hole closed, promoting healing and preventing complications like infection or leakage of bowel contents.

This service was performed 31 times for 30 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $22.92 for a new patient copayment and $25.8 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 33458 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.

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. Nicole Sousa is affiliated with the following medical facilities:

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