MR. WALTER P PINSON M.D.
NPI 1285648048
Internal Medicine in Sylacauga, AL


Quality Rating: 60 out of 100 score

NPI Status: Active since July 28, 2006

Contact Information

209 W SPRING ST
SUITE 200
SYLACAUGA, AL
ZIP 35150
Phone: (256) 245-5241
Fax: (256) 245-0194

Get Directions Reviews

  • Individual
  • Male
  • Internal Medicine
  • PECOS Enrolled
  • Medicare Quality Reporting

About WALTER PINSON

Walter Pinson is an internist established in Sylacauga, Alabama and his medical specialization is Internal Medicine. The healthcare provider is registered in the NPI registry with number 1285648048 assigned on July 2006. The practitioner's primary taxonomy code is 207R00000X with license number 5979 (AL). The provider is registered as an individual and his NPI record was last updated 16 years ago.

NPI
1285648048
Provider Name
MR. WALTER P PINSON M.D.
Gender
Male
Entity Type
Individual
Location Address
209 W SPRING ST SUITE 200 SYLACAUGA, AL 35150
Location Phone
(256) 245-5241
Location Fax
(256) 245-0194
Mailing Address
209 W SPRING ST SUITE 200 SYLACAUGA, AL 35150
Mailing Phone
(256) 245-5241
Mailing Fax
(256) 245-0194
Is Sole Proprietor?
No
Enumeration Date
07-28-2006
Last Update Date
05-16-2008
Code Navigator

An internist like Walter Pinson 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.

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 60, 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 following quality measures were reported for this provider: annual registration in the prescription drug monitoring program, consultation of the prescription drug monitoring program, documentation of current medications in the medical record, e-prescribing, immunization registry reporting, patient-specific education, pneumococcal vaccination status for older adults, preventive care and screening: body mass index (bmi) screening and follow-up plan, preventive care and screening: influenza immunization, preventive care and screening: tobacco use: screening and cessation intervention, provide patient access, secure messaging, security risk analysis, specialized registry reporting, tobacco use and use of high-risk medications in the elderly.

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

Taxonomy Code
207R00000X
Type
Allopathic & Osteopathic Physicians
License No.
5979
License State
AL
Taxonomy Description
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Insurance Plans Accepted

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

  • Blue Cross and Blue Shield of Alabama

    • Blue HSA Bronze - PPO
    • Blue Protect - PPO
    • Blue Saver Bronze - PPO
    • Blue Value Gold - PPO
    • Blue Value Silver - PPO
    • Blue Access Gold for Business - PPO
    • Blue Choice Platinum for Business - PPO
    • Blue HSA Silver for Business - PPO
    • Blue Saver Bronze for Business - PPO
    • Blue Saver Gold for Business - PPO
    • Blue Secure Gold for Business - PPO
    • Blue Secure Silver for Business - PPO
  • Blue Cross Blue Shield

  • Medicare

  • Medicaid

  • Railroad Medicare


*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
51078540OTHER (01)ALBLUE CROSS
000078540MEDICARE ID-TYPE UNSPECIFIED (04)AL 
110229295OTHER (01)ALRAILROAD MEDICARE
C73903MEDICARE UPIN (02)AL 
009971320MEDICAID (05)AL 

PECOS Enrollment and Medicare Participation Status

Walter Pinson 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

  • Other DME (D1E)

    Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (HCPCS:A4253)

    9 DME suppliers used 36 Medicare Claims 77 Services Paid

  • Other DME (D1E)

    Lancets, per box of 100 (HCPCS:A4259)

    6 DME suppliers used 16 Medicare Claims 17 Services Paid

  • Other DME (D1E)

    Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) (HCPCS:E0466)

    2 DME suppliers used 11 Medicare Claims 11 Services Paid

  • Oxygen and supplies (D1C)

    Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)

    4 DME suppliers used 53 Medicare Claims 53 Services Paid

  • Oxygen and supplies (D1C)

    Portable oxygen concentrator, rental (HCPCS:E1392)

    1 DME suppliers used 12 Medicare Claims 12 Services Paid

  • Drugs Administered through DME (D1G)

    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)

    3 DME suppliers used 18 Medicare Claims 2240 Services Paid

  • Wheelchairs (D1D)

    Standard wheelchair (HCPCS:K0001)

    1 DME suppliers used 29 Medicare Claims 29 Services Paid

Drugs and Nutritional Products

  • Other drugs (O1E)

    Pharmacy dispensing fee for inhalation drug(s); per 30 days (HCPCS:Q0513)

    5 DME suppliers used 23 Medicare Claims 23 Services Paid

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 35150 ZIP code area.

New Patients Visit Costs *

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

  • Average New Patient Price $129.05
  • Minimum New Patient Price $55.54
  • Maximum New Patient Price $170.61
  • Average New Patient Copayment $32.26
  • Minimum New Patient Copayment $13.88
  • Maximum New Patient Copayment $42.65

Established Patients Visit Costs *

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

  • Average Established Patient Price $99.33
  • Minimum Established Patient Price $16.93
  • Maximum Established Patient Price $139.08
  • Average Established Patient Copayment $24.83
  • Minimum Established Patient Copayment $4.23
  • Maximum Established Patient Copayment $34.77

* 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 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: 60 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 following quality measures meet Medicare's statistical reporting standards for the year 2018. 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
Annual registration in the Prescription Drug Monitoring ProgramYesN/A
Annual registration by eligible clinician or group in the prescription drug monitoring program of the state where they practice. Activities that simply involve registration are not sufficient. MIPS eligible clinicians and groups must participate for a minimum of 6 months.
Consultation of the Prescription Drug Monitoring ProgramYesN/A
Clinicians would attest to reviewing the patients’ history of controlled substance prescription using state prescription drug monitoring program (PDMP) data prior to the issuance of a Controlled Substance Schedule II (CSII) opioid prescription lasting longer than 3 days. For the transition year, clinicians would attest to 60 percent review of applicable patient’s history. For the Quality Payment Program Year 2 and future years, clinicians would attest to 75 percent review of applicable patient’s history performance.
Documentation of Current Medications in the Medical Record 98% 3259
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration
e-Prescribing 92% 762
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Immunization Registry ReportingYesN/A
The MIPS eligible clinician is in active engagement with a public health agency to submit immunization data.
Patient-Specific Education 11% 576
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.
Pneumococcal Vaccination Status for Older Adults 28% 380
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 98% 1048
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
Preventive Care and Screening: Influenza Immunization 17% 788
Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 49% 244
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Provide Patient Access 66% 576
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 1% 576
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 AnalysisYesN/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.
Specialized Registry ReportingYesN/A
The MIPS eligible clinician is in active engagement to submit data to specialized registry. To earn a 5 % bonus in the promoting interoperability performance category score for submitting to one or more public health or clinical data registries also attest to PI_TRANS_PHCDRR_3_MULTI.
Tobacco useYesN/A
Tobacco use: Regular engagement of MIPS eligible clinicians or groups in integrated prevention and treatment interventions, including tobacco use screening and cessation interventions (refer to NQF #0028) for patients with co-occurring conditions of behavioral or mental health and at risk factors for tobacco dependence.
Use of High-Risk Medications in the Elderly 16% "Inverse Quality Measure"
This is an inverse quality measure, a lower rate means the provider is rated better.
380
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication. 2) Percentage of patients who were ordered at least two of the same high-risk medication

Clinician Services

The following Healthcare Common Procedure Coding System (HCPCS) codes were publicly reported as the top services rendered by this provider under the Medicare program for the year 2020. The reported codes are based on the top 5 codes for each available specialty, excluding evaluation and management codes.

  • 688

    Injection, triamcinolone acetonide, not otherwise specified, 10 mg (HCPCS:J3301)

  • 50

    Administration of influenza virus vaccine (HCPCS:G0008)

  • 41

    Vaccine for influenza for injection into muscle (HCPCS:90662)

  • 36

    Aspiration and/or injection of large joint or joint capsule (HCPCS:20610)

  • 24

    Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit (HCPCS:G0439)

Reviews for MR. WALTER P PINSON M.D.

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1285648048
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
221651241608
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 2 + 1 + 6 + 5 + 1 + 2 + 4 + 1 + 6 + 0 + 8 + 24 = 62
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 62 = 88

The NPI number 1285648048 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1184669483CRADDOCK HEALTH CENTER P C
Organization
Internal Medicine209 W SPRING ST SUITE 200
SYLACAUGA, AL 35150
(256) 245-5241
1689688111DR. STEPHEN R BOWEN PH.D., M.D.
Individual
Internal Medicine209 W SPRING ST SUITE 200
SYLACAUGA, AL 35150
(256) 245-5241
1780698225DR. LAURA G DEICHMANN M.D.
Individual
Internal Medicine209 W SPRING ST SUITE 200
SYLACAUGA, AL 35150
(256) 245-5241
1073527826DR. MOHAMED AMMAR ALDAHER M.D.
Individual
Internal Medicine209 W SPRING ST SUITE 200
SYLACAUGA, AL 35150
(256) 245-5241
1093725624MR. IMAD KHDAIR MD
Individual
Internal Medicine209 W SPRING ST SUITE 200
SYLACAUGA, AL 35150
(256) 245-5241
1861503831MRS. TERESA K PAYTON PT
Individual
Physical Therapist209 W SPRING ST SUITE 302
SYLACAUGA, AL 35150
(256) 249-2249
1356531099COOSA VALLEY PEDIATRICS
Organization
Pediatrics209 W SPRING ST SUITE 304
SYLACAUGA, AL 35150
(256) 208-0060
1306071550MR. WILLIAM THOMAS WRIGHT MSSW, LCSW
Individual
Social Worker (Clinical)209 W SPRING ST SUITE 304
SYLACAUGA, AL 35150
(256) 401-4695
1962790816ORTHOSPORTS ASSOCIATES, LLC
Organization
Orthopaedic Surgery209 W SPRING ST SUITE 301
SYLACAUGA, AL 35150
(205) 249-2249
1861596090 RENEE S DAVIS M.D.
Individual
Family Medicine209 W SPRING ST SUITE 102
SYLACAUGA, AL 35150
(256) 401-4686
1205923554 CLAYTON H. DAVIS M.D.
Individual
Family Medicine209 W SPRING ST SUITE 102
SYLACAUGA, AL 35150
(256) 401-4686
1770874695 ANTHONY JEROME NIX JR. M.D.
Individual
Family Medicine209 W SPRING ST SUITE 100
SYLACAUGA, AL 35150
(256) 401-4686
1083014658PATHWAY PEDIATRICS, INC.
Organization
Pediatrics209 W SPRING ST SUITE 300
SYLACAUGA, AL 35150
(256) 208-0060
1912049420DR. LESLIE ROBINSON SAWYER M.D.
Individual
Pediatrics209 W SPRING ST SUITE 300
SYLACAUGA, AL 35150
(256) 208-0060
1821101320HEMATOLOGY AND ONCOLOGY ASSOCIATES OF ALABAMA, LLC
Organization
Internal Medicine (Hematology & Oncology)209 W SPRING ST SUITE 303
SYLACAUGA, AL 35150
(256) 401-0417
1073904561MS. LAURA TUBBS CRNP
Individual
Nurse Practitioner (Pediatrics)209 W SPRING ST #300
SYLACAUGA, AL 35150
(256) 208-0060
1790773380DR. ALICE MANSELL HARDY M.D.
Individual
Pediatrics209 W SPRING ST SUITE 300
SYLACAUGA, AL 35150
(256) 208-0060
1912135542TROPEANO ORTHOPAEDICS AND SPORTS MEDICINE
Organization
Orthopaedic Surgery (Sports Medicine)209 W SPRING ST SUITE 301
SYLACAUGA, AL 35150
(256) 208-0118
1003261033 KRISTEN LAWHORN CRNP
Individual
Nurse Practitioner (Primary Care)209 W SPRING ST SUITE 300
SYLACAUGA, AL 35150
(256) 208-0060
1588691224 MICHAEL G MARTIN M.D.
Individual
Orthopaedic Surgery209 W SPRING ST SUITE 302
SYLACAUGA, AL 35150
(256) 249-2249

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1285648048, enumerated in the NPI registry as an "individual" on July 28, 2006

The provider is located at 209 W Spring St Suite 200 Sylacauga, Al 35150 and the phone number is (256) 245-5241

The provider's speciality is Internal Medicine with taxonomy code 207R00000X

The provider might be accepting Accepts: Blue Cross and Blue Shield of Alabama, Blue Cross. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Yes, as of May 10, 2024 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary 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.

Medicare beneficiaries should expect a typical cost of $129.05 with an average copayment of $32.26 for new patient appointments. Established patients should expect a typical charge of $99.33 and an average copayment of 24.83. Please review your insurance plan or contact the provider directly to determine your specific costs.

The most common procedures or services performed by this practitioner are: Injection, triamcinolone acetonide, not otherwise specified, 10 mg, Administration of influenza virus vaccine, Vaccine for influenza for injection into muscle, Aspiration and/or injection of large joint or joint capsule and Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit.

This NPI record was last updated on July 28, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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