THOMAS E FLYNN M.D. NPI 1316961048
Ophthalmology in New York, NY
About THOMAS E FLYNN M.D.
Thomas Flynn is a provider established in New York, New York and his medical specialization is Ophthalmology with more than 38 years of experience. He graduated from George Washington University School Of Medicine in 1986. The NPI number of this provider is 1316961048 and was assigned on July 2006. The practitioner's primary taxonomy code is 207W00000X with license number 173604-1 (NY). The provider is registered as an individual and his NPI record was last updated 16 years ago.
| NPI | 1316961048 |
| Provider Name | THOMAS E FLYNN M.D. |
| Location Address | 635 W 165TH ST BOX 92 NEW YORK, NY 10032 |
| Location Phone | (212) 305-3039 |
| Mailing Address | 635 W 165TH ST BOX 92 NEW YORK, NY 10032 |
| Gender | Male |
| NPI Entity Type | Individual |
| Medical School Name | GEORGE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 1986 |
| Is Sole Proprietor? | Yes |
| Enumeration Date | 07-26-2006 |
| Last Update Date | 07-08-2007 |
Thomas Flynn 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.
Thomas Flynn is registered with Medicare and accepts claims assignment, this means the provider accepts Medicare's approved amount for the cost of rendered services as full payment. Participating providers may not charge Medicare beneficiaries more than Medicare's approved amount for their services. Medicare beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.
The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 96.02, 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: age-related macular degeneration (amd): dilated macular examination, engagement of new medicaid patients and follow-up, implementation of documentation improvements for practice/process improvements, implementation of improvements that contribute to more timely communication of test results, implementation of use of specialist reports back to referring clinician or group to close referral loop, provide 24/7 access to mips eligible clinicians or groups who have real-time access to patient's medical record and tobacco use.
The typical physician office visit costs for Medicare beneficiaries in this area are: $39.54 for a new patient copayment and $21.49 for an established patient copayment.
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.
| Taxonomy Code | 207W00000X |
| Classification | Ophthalmology |
| Type | Allopathic & Osteopathic Physicians |
| License No. | 173604-1 |
| 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. |
Accepted Insurance
The NPI profile data indicates this provider might be enrolled and accepting health plans from the following insurance companies or healthcare programs:
- Medicaid
- Medicare
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Business Address
635 W 165TH ST
BOX 92
NEW YORK, NY
ZIP 10032
Phone: (212) 305-3039
Mailing Address
635 W 165TH ST
BOX 92
NEW YORK, NY
ZIP 10032
Phone: (212) 305-3039
Location Map
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 Medicare providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in the Medicare program need to enroll in PECOS with their NPI number to avoid denied claims.
| Registered in PECOS? | Yes |
| PECOS PAC ID | 2567404924 |
| PECOS Enrollment ID | I20050525000898, I20081112000475 |
| 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 order / refer Part B Clinical Laboratory and Imaging | Yes |
| Eligible order or refer Durable Medical Equipment (DMEPOS) | Yes |
| Eligible order r refer Home Health Agency (HHA) | Yes |
| Eligible order r refer Power Mobility Devices | Yes |
Physician Office Visit Costs
The provider accepts as payment the Medicare approved amount. Medicare beneficiaries should not be billed for more than the Medicare deductible and coinsurance amounts. Medicare pricing is usually a reference point for private insurance covered patients. The prices below reflect the costs for new and established patients in the 10032 ZIP code area.
| New Patients Office Visits Costs * | ||
|---|---|---|
| Most Utilized Procedure Code for new patients office visits: 99204 | ||
| Minimum New Patient Pricing | Maximum New Patient Pricing | Typical New Patient Pricing |
| $69.45 | $208.72 | $158.18 |
| Minimum New Patient Copayment | Maximum New Patient Copayment | Typical New Patient Copayment |
| $17.36 | $52.18 | $39.54 |
| Established Patients Office Visits Costs * | ||
|---|---|---|
| Most Utilized Procedure Code for established patients office visits: 99213 | ||
| Minimum Established Patient Pricing | Maximum Established Patient Pricing | Typical Established Patient Pricing |
| $21.65 | $169.66 | $85.96 |
| Minimum Established Patient Copayment | Maximum Established Patient Copayment | Typical Established Patient Copayment |
| $5.41 | $42.41 | $21.49 |
* The physician office visit costs information is obtained by Medicare's 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 Medicare's 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.
| MIPS Measure | Score Weight | Score | |
|---|---|---|---|
| Quality | 40% | 92.04 | |
|
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 (PI) | 25% | 100 | |
|
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 | 15% | 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 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 | 20% | 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. |
|||
| MIPS Final Score | - | 96.02 | |
| 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 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 |
|---|---|---|
| Age-Related Macular Degeneration (AMD): Dilated Macular Examination | 100% | 301 |
| Percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage AND the level of macular degeneration severity during one or more office visits within 12 months | ||
| Engagement of New Medicaid Patients and Follow-up | Yes | N/A |
| Seeing new and follow-up Medicaid patients in a timely manner, including individuals dually eligible for Medicaid and Medicare. A timely manner is defined as within 10 business days for this activity. | ||
| Implementation of documentation improvements for practice/process improvements | Yes | N/A |
| Implementation of practices/processes that document care coordination activities (e.g., a documented care coordination encounter that tracks all clinical staff involved and communications from date patient is scheduled for outpatient procedure through day of procedure). | ||
| Implementation of improvements that contribute to more timely communication of test results | Yes | N/A |
| Timely communication of test results defined as timely identification of abnormal test results with timely follow-up. | ||
| Implementation of Use of Specialist Reports Back to Referring Clinician or Group to Close Referral Loop | Yes | N/A |
| Performance of regular practices that include providing specialist reports back to the referring individual MIPS eligible clinician or group to close the referral loop or where the referring individual MIPS eligible clinician or group initiates regular inquiries to specialist for specialist reports which could be documented or noted in the EHR technology. | ||
| Provide 24/7 Access to MIPS Eligible Clinicians or Groups Who Have Real-Time Access to Patient's Medical Record | Yes | N/A |
| • Provide 24/7 access to MIPS eligible clinicians, groups, or care teams for advice about urgent and emergent care (e.g., MIPS eligible clinician and care team access to medical record, cross-coverage with access to medical record, or protocol-driven nurse line with access to medical record) that could include one or more of the following: • Expanded hours in evenings and weekends with access to the patient medical record (e.g., coordinate with small practices to provide alternate hour office visits and urgent care); • Use of alternatives to increase access to care team by MIPS eligible clinicians and groups, such as e-visits, phone visits, group visits, home visits and alternate locations (e.g., senior centers and assisted living centers); and/or Provision of same-day or next-day access to a consistent MIPS eligible clinician, group or care team when needed for urgent care or transition management. | ||
| Tobacco use | Yes | N/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. | ||
Clinician Utilization
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 2017. The reported codes are based on the top 5 codes for each available Medicare specialty, excluding evaluation and management codes.
- 785Diagnostic imaging of retina (HCPCS:92134)
- 481Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits (HCPCS:92014)
- 411Photography of the retina (HCPCS:92250)
- 218Eye and medical examination for diagnosis and treatment, established patient (HCPCS:92012)
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 |
|---|---|---|
| 83K351 | MEDICARE ID-TYPE UNSPECIFIED (04) | |
| 01471181 | MEDICAID (05) | NY |
| E66152 | MEDICARE UPIN (02) |
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 | 3 | 1 | 6 | 9 | 6 | 1 | 0 | 4 | 8 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 3 | 2 | 6 | 18 | 6 | 2 | 0 | 8 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 3 + 2 + 6 + 1 + 8 + 6 + 2 + 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 = 8 | 8 | ||||||||
The NPI number 1316961048 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 |
|---|---|---|---|
| 1588627988 | DR. RAJENDRA K. BANSAL MD Individual | Ophthalmology | 635 W 165TH ST SUITE 104 NEW YORK, NY 10032 (212) 350-2241 |
| 1871547752 | SUSAN JEAN LEE M.D. Individual | Ophthalmology | 635 W 165TH ST FLANZER SUITE NEW YORK, NY 10032 (212) 305-9535 |
| 1992741722 | DR. MARY SCIUTTO M.D. Individual | Psychiatry & Neurology (Psychiatry) | 635 W 165TH ST INTENSIVE OUTPATIENT PROGRAM - EI 4TH FLOOR NEW YORK, NY 10032 (212) 305-9758 |
| 1689600363 | DR. REZA IRANMANESH MD Individual | Ophthalmology | 635 W 165TH ST NEW YORK, NY 10032 (212) 305-0648 |
| 1295764306 | DR. BENJAMIN MCCOMMON M.D. Individual | Psychiatry & Neurology (Psychiatry) | 635 W 165TH ST INTENSIVE OUTPATIENT PROGRAM NEW YORK, NY 10032 (212) 305-9758 |
| 1508895517 | DR. RICHARD HERSH M.D. Individual | Psychiatry & Neurology (Psychiatry) | 635 W 165TH ST INTENSIVE OUTPATIENT PROGRAM - EI 4TH FLOOR NEW YORK, NY 10032 (212) 305-9758 |
| 1861421877 | DR. CECILIA DINTINO PH.D. Individual | Psychologist | 635 W 165TH ST INTENSIVE OUTPATIENT PROGRAM - EI 4TH FLOOR NEW YORK, NY 10032 (212) 305-9758 |
| 1912936881 | DR. ANTHONY TRANGUCH M.D. Individual | Psychiatry & Neurology (Psychiatry) | 635 W 165TH ST INTENSIVE OUTPATIENT PROGRAM - EI 4TH FLOOR NEW YORK, NY 10032 (212) 305-9758 |
| 1376576892 | TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK Organization | Ophthalmology | 635 W 165TH ST FLANZER SUITE NEW YORK, NY 10032 (212) 305-9535 |
| 1508883497 | HERMANN D SCHUBERT M.D. Individual | Ophthalmology | 635 W 165TH ST NEW YORK, NY 10032 (212) 305-6534 |
| 1174542542 | DR. MARK JOHN DONALDSON MBBS(HONS) Individual | Ophthalmology | 635 W 165TH ST COLUMBIA UNIVERSITY MEDICAL CENTER NEW YORK, NY 10032 (212) 305-2725 |
| 1265452213 | MICHAEL KAZIM M.D. Individual | Ophthalmology | 635 W 165TH ST NEW YORK, NY 10032 (212) 305-5477 |
| 1982624201 | MAX FORBES M.D. Individual | Ophthalmology | 635 W 165TH ST BOX 92 NEW YORK, NY 10032 (212) 305-9535 |
| 1518987643 | HOWARD M EGGERS M.D. Individual | Ophthalmology | 635 W 165TH ST NEW YORK, NY 10032 (212) 305-5409 |
| 1629098991 | WILLIAM M SCHIFF M.D. Individual | Ophthalmology | 635 W 165TH ST BOX 92 NEW YORK, NY 10032 (212) 305-9535 |
| 1659394294 | DR. STEVEN KANE M.D. Individual | Ophthalmology | 635 W 165TH ST ROOM 102 NEW YORK, NY 10032 (212) 305-5400 |
| 1689698938 | GAETANO BARILE M.D. Individual | Ophthalmology | 635 W 165TH ST NEW YORK, NY 10032 (212) 305-9535 |
| 1043234255 | GEORGE HOWARD M.D. Individual | Ophthalmology | 635 W 165TH ST NEW YORK, NY 10032 (212) 305-5400 |
| 1962419218 | AMILIA SCHRIER M.D. Individual | Ophthalmology | 635 W 165TH ST NEW YORK, NY 10032 (212) 305-9535 |
| 1801803150 | RICHARD E BRAUNSTEIN M.D. Individual | Ophthalmology | 635 W 165TH ST BOX 92 NEW YORK, NY 10032 (212) 305-9535 |
Frequently Asked Questions
What is Thomas Flynn M.D. NPI number?
The NPI number assigned to this healthcare provider is 1316961048, registered as an "individual" on July 26, 2006
Where is the provider located?
The provider is located at 635 W 165th St Box 92 New York, Ny 10032 and the phone number is (212) 305-3039
What is the provider specialty code?
The provider's speciality is Ophthalmology with taxonomy code 207W00000X
How many years of experience does Thomas Flynn M.D. have?
The provider has more than 38 years of experience. He graduated from George Washington University School Of Medicine in 1986.
What insurance does Thomas Flynn M.D. accept?
The provider might be accepting Medicaid and Medicare. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Is Thomas Flynn M.D. registered in PECOS?
Yes, as of September 14, 2023 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a Medicare 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.
What are Thomas Flynn M.D. Quality Ratings?
The provider has an overall high rating in the following quality measures: quality clinical practices and patient outcomes and experiences , uses technology to exchange and make use of healthcare information.
How much is a visit to Thomas Flynn M.D.?
Medicare beneficiaries should expect a typical cost of $158.18 with an average copayment of $39.54 for new patient appointments. Established patients should expect a typical charge of $85.96 and an average copayment of 21.49. Please review your insurance plan or contact the provider directly to determine your specific costs.
What are some of the services provided by Thomas Flynn M.D.?
The most common procedures or services performed by this practitioner are: Diagnostic imaging of retina, Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits, Photography of the retina and Eye and medical examination for diagnosis and treatment, established patient.
How do I update my NPI information?
This NPI record was last updated on July 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].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.