KENNETH J ROSENTHAL MD
NPI 1295750230
Ophthalmology in Great Neck, NY
Quality Rating: 60.24 out of 100 score
NPI Status: Active since July 12, 2006
Contact Information
310 E SHORE RD
SUITE 102
GREAT NECK, NY
ZIP 11023
Phone: (516) 466-8989
Fax: (516) 466-8962
- Individual
- Male
- Years of Experience 48
- Ophthalmology
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
- Medicare Quality Reporting
- CLIA Number: 33D1080242
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 08-19-2025
About KENNETH ROSENTHAL
This page provides the complete NPI Profile along with additional information for Kenneth Rosenthal, a provider established in Great Neck, New York with a medical specialization in Ophthalmology and more than 48 years of experience. The healthcare provider is registered in the NPI registry with number 1295750230 assigned on July 2006. The practitioner's primary taxonomy code is 207W00000X with license number 138603 (NY). The provider is registered as an individual and his NPI record was last updated 18 years ago.
- NPI
- 1295750230
- Provider Name
- KENNETH J ROSENTHAL MD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 310 E SHORE RD SUITE 102 GREAT NECK, NY 11023
- Location Phone
- (516) 466-8989
- Location Fax
- (516) 466-8962
- Mailing Address
- 310 E SHORE RD SUITE 102 GREAT NECK, NY 11023
- Mailing Phone
- (516) 466-8989
- Mailing Fax
- (516) 466-8962
- Medical School Name
- OTHER
- Graduation Year
- 1978
- Is Sole Proprietor?
- No
- Enumeration Date
- 07-12-2006
- Last Update Date
- 02-11-2008
- Code Navigator
Ophthalmologists like Kenneth Rosenthal specialize in diagnosing and treating eye conditions. They may perform surgeries to correct vision issues or prevent vision loss due to diseases like glaucoma. Additionally, they can provide eyeglasses, prescribe contact lenses, and offer other vision-related services.
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
Ophthalmology
- Taxonomy Code
- 207W00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 138603
- License State
- NY
- Taxonomy Description
- An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Max 70/50 $6700 - PPO
- Blue Max 90/70 $1500 - PPO
- Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $3300 - PPO
- Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan - PPO
- Blue Max Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan - PPO
- Blue Max Copay (PCP, Specialist, Urgent Care) 75/55 $1500 Standardized Plan - PPO
- Blue Saver 60/40 $6100 - PPO
- Blue Saver 90/70 $3200 - PPO
- BlueSelect Bronze Basic - PPO
- BlueSelect Bronze Core - PPO
- BlueSelect Expanded Bronze Standard without Kid's Dental - PPO
- BlueSelect Gold Core - PPO
- BlueSelect Gold HealthPlus - PPO
- BlueSelect Gold Standard without Kid's Dental - PPO
- BlueSelect Silver Classic - PPO
- BlueSelect Silver Classic without Kid's Dental - PPO
- BlueSelect Silver HealthPlus - PPO
- BlueSelect Silver HealthPlus without Kid's Dental - PPO
- BlueSelect Silver Standard without Kid's Dental - PPO
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 |
|---|---|---|---|
| 20A721 | MEDICARE PIN (08) | NY | |
| B10907 | MEDICARE UPIN (02) | NY |
Medicare Participation & PECOS Enrollment Status
Kenneth Rosenthal 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.
Kenneth Rosenthal 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: 3779640974
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: I20090313000510
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.
Cataract surgery
Complex removal of cataract with insertion of prosthetic lens
Ct scan of cornea
Established patient complete exam of visual system
Established patient problem focused exam of visual system
Exam of visual field with extended testing
Imaging of front third of eye
Imaging of front third of eye using a special microscope
Imaging of optic nerve
Imaging of retina
Measurement of corneal curvature and depth of eye
Microfluid analysis of tears
New patient complete exam of visual system
New patient problem focused exam of visual system
Photography of the retina
Removal of cataract with insertion of prosthetic lens
Removal of recurring cataract in lens capsule using a laser
Cataract surgery is a procedure to remove the lens of your eye when it becomes cloudy, which is called a cataract. A synthetic lens is then inserted to restore clear vision. The operation is typically done on an outpatient basis and is very safe and effective.
This service was performed for 214 patientsThis procedure involves removing a cloudy lens (cataract) from your eye and replacing it with a clear, artificial lens. It helps restore vision that has been affected by the cataract. The operation is usually done under local anesthesia.
This service was performed 19 times for 17 patientsA CT scan of the cornea is a non-invasive imaging test that uses X-rays to capture detailed pictures of your eye's cornea. It helps in diagnosing diseases or damage, planning for surgery, or evaluating the results of a treatment. It's a safe and painless procedure.
This service was performed 48 times for 44 patientsAn established patient complete exam of the visual system involves a thorough check of your eyes and vision. It assesses eye health, checks for diseases, and measures your ability to see clearly at different distances. It's a routine, non-invasive procedure.
This service was performed 399 times for 359 patientsThis is a routine check-up for existing patients focusing on the visual system. It involves examining your eyes to detect any potential issues or changes in your vision. It's a crucial part of maintaining good eye health.
This service was performed 902 times for 403 patientsAn extended visual field exam is a detailed test to evaluate your peripheral (side) vision. It helps to detect any potential blind spots which may not be noticeable in daily life. These could be caused by eye diseases like glaucoma, or neurological conditions.
This service was performed 160 times for 117 patientsImaging of the front third of the eye, also known as anterior segment imaging, captures detailed images of the eye's front part. This includes the iris, cornea, and lens. It's a non-invasive procedure that helps diagnose and monitor eye conditions.
This service was performed 21 times for 20 patientsThis procedure involves capturing detailed images of the front part of your eye using a specialized microscope. It helps in identifying any eye abnormalities or issues, improving the accuracy of diagnosis and treatment planning.
This service was performed 113 times for 104 patientsImaging of the optic nerve is a non-invasive procedure that captures detailed pictures of your optic nerve. It helps doctors assess eye health, particularly for conditions like glaucoma. It's painless, quick, and uses safe technology like MRI or OCT (Optical Coherence Tomography).
This service was performed 144 times for 111 patientsImaging of the retina is a non-invasive procedure that captures detailed images of your eye's interior. This helps detect conditions like macular degeneration or retinal detachment. It's painless and takes only a few minutes.
This service was performed 234 times for 177 patientsThis procedure measures the shape and depth of your eye, specifically the cornea, the clear front surface. It helps in diagnosing conditions, planning for surgeries, or fitting contact lenses. It's non-invasive and painless.
This service was performed 145 times for 105 patientsMicrofluid analysis of tears involves collecting a small tear sample to examine its composition. This procedure can help detect health issues like dry eye disease, inflammation, or other eye conditions. It's a non-invasive, painless method for monitoring eye health.
This service was performed 619 times for 221 patientsA new patient complete exam of the visual system is a thorough evaluation of your eyes and vision. It checks for any potential issues and assesses overall eye health. It includes tests for visual acuity, eye movement, and light response.
This service was performed 120 times for 120 patientsA new patient problem-focused exam of the visual system is a basic evaluation of your eyes and vision. It includes checking your eye movements, visual acuity, and general eye health. It helps detect any potential issues early for timely treatment.
This service was performed 36 times for 36 patientsPhotography of the retina, also known as retinal imaging, is a non-invasive procedure that captures images of the back of your eye. This helps doctors identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. It's painless and quick, often part of a routine eye exam.
This service was performed 23 times for 23 patientsThis is a procedure where a cloudy lens in your eye, known as a cataract, is removed. After removal, a clear artificial lens is inserted. This helps to restore your vision, enabling you to see clearly again.
This service was performed 120 times for 76 patientsThis procedure, known as YAG laser capsulotomy, treats cloudiness in the lens capsule following cataract surgery. A laser is used to create a small hole in the cloudy capsule, allowing light to pass through and restore clear vision. It's a quick, painless procedure.
This service was performed 85 times for 65 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $38.57 for a new patient copayment and $20.86 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 11023 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $154.28
- Minimum New Patient Price $67.4
- Maximum New Patient Price $203.53
- Average New Patient Copayment $38.57
- Minimum New Patient Copayment $16.85
- Maximum New Patient Copayment $50.88
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $83.44
- Minimum Established Patient Price $21.66
- Maximum Established Patient Price $164.45
- Average Established Patient Copayment $20.86
- Minimum Established Patient Copayment $5.41
- Maximum Established Patient Copayment $41.11
* 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 60.24, 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.
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Final Score: 60.24 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: 61.14
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: 19.29
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: 19.29
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 provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. 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 |
|---|---|---|
| Engagement of patients through implementation of improvements in patient portal | Yes | N/A |
| Access to an enhanced patient portal that provides up to date information related to relevant chronic disease health or blood pressure control, and includes interactive features allowing patients to enter health information and/or enables bidirectional communication about medication changes and adherence. | ||
| e-Prescribing | 91% | 330 |
| At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology. | ||
| Provide Patient Access | 0% | 512 |
| 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. | ||
| Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms. | Yes | N/A |
| Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms. | ||
| Secure Messaging | 2% | 512 |
| 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 Analysis | Yes | N/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. | ||
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 33D1080242
- Facility Type
- Physician Office
- Certificate Effective Date
- August 20, 2023
- Certificate Expiration Date
- August 19, 2025
- Laboratory Director
- DR. KENNETH J. ROSENTHAL
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Kenneth Rosenthal to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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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. | |||||||||
| 1 | 2 | 9 | 5 | 7 | 5 | 0 | 2 | 3 | 0 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 2 | 18 | 5 | 14 | 5 | 0 | 2 | 6 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 2 + 1 + 8 + 5 + 1 + 4 + 5 + 0 + 2 + 6 + 24 = 60 | |||||||||
| Step 3: because the number obtained in step 2 ends in zero, the check digit is zero. | |||||||||
| 0 | |||||||||
The NPI number 1295750230 is valid because the calculated check digit 0 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.
DR. ROBERT DON HERMAN
Internal Medicine
(Gastroenterology)
310 E SHORE RD
206
GREAT NECK, NY
ZIP 11023
DR. GINA SUE KWAK M.D.
Internal Medicine
(Gastroenterology)
310 E SHORE RD
206
GREAT NECK, NY
ZIP 11023
DR. STEPHEN ROBERT SIEGEL M.D.
Internal Medicine
(Gastroenterology)
310 E SHORE RD
206
GREAT NECK, NY
ZIP 11023
DR. MICHAEL JOEL GOLDSTEIN M.D.
Internal Medicine
(Gastroenterology)
310 E SHORE RD
206
GREAT NECK, NY
ZIP 11023
DR. JOEL GOLDBERG MD
Internal Medicine
(Cardiovascular Disease)
310 E SHORE RD
SUITE 104
GREAT NECK, NY
ZIP 11023
DIMITRA THEODOROPOULOS M.D., FACS
Surgery
310 E SHORE RD
SUITE 203
GREAT NECK, NY
ZIP 11023
DR. NANCY SUE WOLFIN M.D.
Dermatology
(Procedural Dermatology)
310 E SHORE RD
204
GREAT NECK, NY
ZIP 11023
DR. JOSE LUIS SELIGSON M.D.
Psychiatry & Neurology
(Psychiatry)
310 E SHORE RD
SUITE 301
GREAT NECK, NY
ZIP 11023
SEYMOUR H. BLOCK D.O.
Psychiatry & Neurology
(Psychiatry)
310 E SHORE RD
SUITE #201
GREAT NECK, NY
ZIP 11023
DR. HOWARD M ROMBOM PHD
Psychologist
310 E SHORE RD
SUITE 100
GREAT NECK, NY
ZIP 11023
DR. DAVID ZARABI D.D.S.
Dentist
(Orthodontics and Dentofacial Orthopedics)
310 E SHORE RD
SUITE 101
GREAT NECK, NY
ZIP 11023
KENNETH J ROSENTHAL MD PC
Specialist
310 E SHORE RD
SUITE 102
GREAT NECK, NY
ZIP 11023
DR. SUSAN JACOBSON
Psychologist
(Clinical Child & Adolescent)
310 E SHORE RD
SUITE 301
GREAT NECK, NY
ZIP 11023
DR. MICHELLE KLEIN D.C., C.N.S.
Chiropractor
(Nutrition)
310 E SHORE RD
SUITE 305
GREAT NECK, NY
ZIP 11023
DR. DAVID RHEE DDS
Dentist
310 E SHORE RD
SUITE 101
GREAT NECK, NY
ZIP 11023
DR. ALLEN LAWRENCE FINKELSTEIN DDS
Dentist
310 E SHORE RD
GREAT NECK, NY
ZIP 11023
DR. KARISSA LYNN MAGGIO DC
Chiropractor
310 E SHORE RD
GREAT NECK, NY
ZIP 11023
ALLAN I. STEMPLER, M.D., P.C.
Clinic/Center
(Adult Mental Health)
310 E SHORE RD
SUITE 301
GREAT NECK, NY
ZIP 11023
MS. ROSEMARIE HAASE FNP
Nurse Practitioner
(Family)
310 E SHORE RD
SUITE 203
GREAT NECK, NY
ZIP 11023
PSYCHOLOGY CARE PC
Psychologist
(Clinical)
310 E SHORE RD
GREAT NECK, NY
ZIP 11023
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1295750230, enumerated as an "individual" on July 12, 2006.
The provider is located at 310 E SHORE RD SUITE 102 GREAT NECK, NY 11023 and the phone number is (516) 466-8989.
Ophthalmology with taxonomy code 207W00000X.
The provider might be accepting Accepts: Blue Cross and Blue Shield of Louisiana, Blue. Please consult your insurance carrier or call the provider to verify.
