MR. SCOTT KEVIN RUSSELL M.P.T.
NPI 1285742742
Physical Therapist in Los Banos, CA


Quality Rating: 60 out of 100 score

NPI Status: Active since August 26, 2006

Contact Information

312 W J ST
LOS BANOS, CA
ZIP 93635
Phone: (209) 827-6178
Fax: (209) 827-6179

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  • Individual
  • Male
  • Years of Experience 27
  • Physical Therapist
  • Accepts Medicare Approved Payment

About SCOTT RUSSELL

Scott Russell is a provider established in Los Banos, California and his medical specialization is Physical Therapist with more than 27 years of experience. The healthcare provider is registered in the NPI registry with number 1285742742 assigned on August 2006. The practitioner's primary taxonomy code is 225100000X with license number PT23597 (CA). The provider is registered as an individual and his NPI record was last updated 9 years ago.

NPI
1285742742
Provider Name
MR. SCOTT KEVIN RUSSELL M.P.T.
Gender
Male
Entity Type
Individual
Location Address
312 W J ST LOS BANOS, CA 93635
Location Phone
(209) 827-6178
Location Fax
(209) 827-6179
Mailing Address
312 W J ST LOS BANOS, CA 93635
Mailing Phone
(209) 827-6178
Mailing Fax
(209) 827-6179
Medical School Name
OTHER
Graduation Year
1998
Is Sole Proprietor?
No
Enumeration Date
08-26-2006
Last Update Date
01-27-2015
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Scott Russell 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.

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 typical physician office visit costs for Medicare beneficiaries in this area are: $23.31 for a new patient copayment and $19.02 for an established patient copayment.

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

Physical Therapist

Taxonomy Code
225100000X
Type
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
License No.
PT23597
License State
CA
Taxonomy Description
Physical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles. PTs:
  • Diagnose and manage movement dysfunction and enhance physical and functional abilities.
  • Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.
  • Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.
  • Treat conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems.
  • Address the negative effects attributable to unique personal and environmental factors as they relate to human performance.
PTs provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a PT practices.

Insurance Plans Accepted

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

  • Medicare

  • Medicaid


*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
PT0235970MEDICAID (05)CA 
PT23597MEDICARE UPIN (02)CA 

PECOS Enrollment and Medicare Participation Status

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.

  • PECOS PAC ID: 2961432000

    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: I20050817001063

    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.

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 93635 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

  • Average New Patient Price $93.25
  • Minimum New Patient Price $60.86
  • Maximum New Patient Price $183.39
  • Average New Patient Copayment $23.31
  • Minimum New Patient Copayment $15.21
  • Maximum New Patient Copayment $45.84

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

  • Average Established Patient Price $76.09
  • Minimum Established Patient Price $19.29
  • Maximum Established Patient Price $150.36
  • Average Established Patient Copayment $19.02
  • Minimum Established Patient Copayment $4.82
  • Maximum Established Patient Copayment $37.59

* 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.

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.

  • 6512

    Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes (HCPCS:97110)

  • 3356

    Manual (physical) therapy techniques to 1 or more regions, each 15 minutes (HCPCS:97140)

  • 587

    Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes (HCPCS:97112)

  • 233

    Evaluation of physical therapy, typically 20 minutes (HCPCS:97161)

  • 50

    Evaluation of physical therapy, typically 30 minutes (HCPCS:97162)

Reviews for MR. SCOTT KEVIN RUSSELL M.P.T.

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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.
1285742742
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
22165144478
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 2 + 1 + 6 + 5 + 1 + 4 + 4 + 4 + 7 + 8 + 24 = 68
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 68 = 22

The NPI number 1285742742 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 15 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1558512327SPORT & REHAB PHYSICAL THERAPY
Organization
Clinic/Center (Physical Therapy)312 W J ST
LOS BANOS, CA 93635
(209) 827-6178
1093016610 SUSANNA RUSSELL MPT
Individual
Physical Therapist312 W J ST
LOS BANOS, CA 93635
(209) 827-6178
1427352913 ESTERE GALENIECE MORENO D.P.T.
Individual
Physical Therapist312 W J ST
LOS BANOS, CA 93635
(250) 982-7617
1497045884MR. LEOPOLDO L REYES P.T.
Individual
Physical Therapist312 W J ST
LOS BANOS, CA 93635
(209) 827-6178
1558610014CENTER FOR SPEECH & LANGUAGE THERAPY
Organization
Speech-Language Pathologist312 W J ST SUITE 202
LOS BANOS, CA 93635
(209) 827-1500
1013307610 GLENN ERNEST FABIAN
Individual
Physical Therapist312 W J ST
LOS BANOS, CA 93635
(209) 827-6178
1316306533 JUDY CAI P.T., D.P.T.
Individual
Physical Therapist312 W J ST
LOS BANOS, CA 93635
(209) 827-6178
1487008314 NATHANIEL MARGATE
Individual
Physical Therapist312 W J ST
LOS BANOS, CA 93635
(209) 827-6178
1083125702 NEPTAHLI SANTARIN PARIAN PT
Individual
Physical Therapist312 W J ST
LOS BANOS, CA 93635
(209) 827-6178
1891254710MS. JESSICA DAMARIS CORDERO
Individual
Physical Medicine & Rehabilitation312 W J ST
LOS BANOS, CA 93635
(209) 827-6178
1669021028 MARILOU TABARANZA MENOR PT
Individual
Physical Therapist312 W J ST
LOS BANOS, CA 93635
(209) 827-6178
1952931230MR. ERIK BURTON NICHOLS MPT
Individual
Physical Therapist (Neurology)312 W J ST
LOS BANOS, CA 93635
(209) 827-6178
1164953519 YASHESH GORADIA MSPT
Individual
Physical Therapist312 W J ST
LOS BANOS, CA 93635
(209) 827-6178
1053033498 IGNACIO PROTTO
Individual
Physical Therapist312 W J ST
LOS BANOS, CA 93635
(209) 827-6178
1396427977DR. MARLOU RUSSEL SORIANO GARCES JR. DPT
Individual
Physical Therapist312 W J ST
LOS BANOS, CA 93635
(209) 827-6178

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1285742742, enumerated in the NPI registry as an "individual" on August 26, 2006

The provider is located at 312 W J St Los Banos, Ca 93635 and the phone number is (209) 827-6178

The provider's speciality is Physical Therapist with taxonomy code 225100000X

The provider has more than 27 years of experience.

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Medicare beneficiaries should expect a typical cost of $93.25 with an average copayment of $23.31 for new patient appointments. Established patients should expect a typical charge of $76.09 and an average copayment of 19.02. 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: Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes, Manual (physical) therapy techniques to 1 or more regions, each 15 minutes, Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes, Evaluation of physical therapy, typically 20 minutes and Evaluation of physical therapy, typically 30 minutes.

This NPI record was last updated on August 26, 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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