MARI GORGA P.A.-C
NPI 1275868259
Physician Assistant in Alameda, CA
Quality Rating: 79.65 out of 100 score
NPI Status: Active since October 09, 2009
Contact Information
430 WILLOW ST
ALAMEDA, CA
ZIP 94501
Phone: (888) 380-0988
Fax: (833) 992-2313
- NPI Profile Information
- Primary Taxonomy
- Secondary Taxonomies
- Insurance Plans Accepted
- Secondary Locations
- Medicare Participation & PECOS Status
- Areas of Expertise
- Durable Medical Equipment
- Physician Visit Costs
- Overall Quality Performance
- Quality Measures
- NPI Validation
- Other Providers Same Location
- Frequently Asked Questions
- Individual
- Female
- Physician Assistant
- Accepts Insurance
- PECOS Enrolled
- Medicare Quality Reporting
About MARI GORGA
This page provides the complete NPI Profile along with additional information for Mari Gorga, a primary care provider established in Alameda, California with a medical specialization in Physician Assistant. The healthcare provider is registered in the NPI registry with number 1275868259 assigned on October 2009. The practitioner's primary taxonomy code is 363A00000X with license number 61622 (CA). The provider is registered as an individual and her NPI record was last updated 4 years ago.
- NPI
- 1275868259
- Provider Name
- MARI GORGA P.A.-C
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 430 WILLOW ST ALAMEDA, CA 94501
- Location Phone
- (888) 380-0988
- Location Fax
- (833) 992-2313
- Mailing Address
- 2950 BUSKIRK AVE STE 300 WALNUT CREEK, CA 94597
- Mailing Phone
- (888) 380-0988
- Mailing Fax
- (833) 992-2313
- Is Sole Proprietor?
- No
- Enumeration Date
- 10-09-2009
- Last Update Date
- 11-15-2022
- Code Navigator
A primary care provider (PCP) like Mari Gorga 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
Secondary Locations
- 300 Neal St
Pleasanton, CA 94566
(888) 380-0988 - 21966 Dolores St
Castro Valley, CA 94546
(888) 380-0988 - 210 40th Street Way
Oakland, CA 94611
(888) 380-0988
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
- Taxonomy Code
- 363A00000X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- License No.
- 61622
- License State
- CA
- Taxonomy Description
- A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
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 | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 5601005621 (MI) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Cross� Premier PPO Bronze Extra - PPO
- Blue Cross� Premier PPO Bronze Saver HSA - PPO
- Blue Cross� Premier PPO Bronze Secure - PPO
- Blue Cross� Premier PPO Gold - PPO
- Blue Cross� Premier PPO Gold Extra - PPO
- Blue Cross� Premier PPO Silver - PPO
- Blue Cross� Premier PPO Silver Extra - PPO
- Blue Cross� Premier PPO Silver Saver HSA - PPO
- Blue Cross� Premier PPO Value - PPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medicare Participation & PECOS Enrollment Status
Mari Gorga 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 (DE000N)
Nebulizer, with compressor (HCPCS:E0570)
3 DME suppliers used 37 Medicare Claims 37 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.
Follow-up nursing facility visit per day, typically 25 minutes
Follow-up nursing facility visit per day, typically 35 minutes
Initial nursing facility visit per day, typically 45 minutes
A follow-up nursing facility visit per day is a daily check-in by a healthcare professional. This 25-minute visit typically involves monitoring your health progress, addressing any concerns, and adjusting treatment plans as necessary. It's a vital part of ensuring your ongoing wellbeing.
This service was performed 56 times for 26 patientsA follow-up nursing facility visit is a routine check-up that typically lasts about 35 minutes. During this visit, your health status is evaluated, any changes in your condition are noted, and necessary adjustments to your care plan are made. It's an essential part of maintaining your health.
This service was performed 35 times for 22 patientsAn initial nursing facility visit is your first meeting with your healthcare team at a nursing facility. Lasting typically 45 minutes, this appointment involves a comprehensive health assessment and the creation of your personalized care plan. It's a crucial step to ensure your health and well-being.
This service was performed 28 times for 28 patientsPhysician 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 94501 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $104.51
- Minimum New Patient Price $69
- Maximum New Patient Price $202.35
- Average New Patient Copayment $26.12
- Minimum New Patient Copayment $17.25
- Maximum New Patient Copayment $50.58
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $84.91
- Minimum Established Patient Price $23.44
- Maximum Established Patient Price $166.46
- Average Established Patient Copayment $21.22
- Minimum Established Patient Copayment $5.86
- Maximum Established Patient Copayment $41.61
* 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 79.65, 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 provider also has detailed performance information the following quality measures: .
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.
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Final Score: 79.65 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.
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Quality Score: 24.13
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.
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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: 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: 100
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: 100
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.
MIPS Quality Measures
The following performance measures were reported under the Merit-Based Incentive Payment System (MIPS) and Qualified Clinical Data Registry (QCDR) quality measures program.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Documentation of Current Medications in the Medical Record | 1% | 2362 |
| Falls: Screening for Future Fall Risk | 59% | 357 |
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | 0% | 399 |
| Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented | 0% | 1524 |
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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 1275868259, we treat the final digit (9) 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 61. The final step is to find the difference between that total and the next multiple of ten (70 - 61 = 9).
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.
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.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 61 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 10 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1275868259, enumerated as an "individual" on October 09, 2009.
The provider is located at 430 WILLOW ST ALAMEDA, CA 94501 and the phone number is (888) 380-0988.
Physician Assistant with taxonomy code 363A00000X.
The provider might be accepting Accepts: Blue Cross Blue Shield of Michigan Mutual. Please consult your insurance carrier or call the provider to verify.
