CHERYL A. MCCLAIN M.D. NPI 1316965700
Internal Medicine (Addiction Medicine) in Lexington, KY
About CHERYL MCCLAIN
Cheryl Mcclain is an internal medicine provider established in Lexington, Kentucky and her medical specialization is internal medicine (addiction medicine) with more than 27 years of experience. She graduated from University Of Kentucky College Of Medicine in 1995. The NPI number of Cheryl Mcclain is 1316965700 and was assigned on July 2006. The practitioner's primary taxonomy code is 207RA0401X with license number 32948 (KY). The provider is registered as an individual and her NPI record was last updated one year ago.
An internist like Cheryl A. Mcclain M.d. 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.
Cheryl Mcclain is enrolled in PECOS and is eligible to order or refer healthcare 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
Cheryl Mcclain 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 94.2, 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: $31.84 for a new patient copayment and $4.16 for an established patient copayment.
| NPI | 1316965700 |
| Provider Name | CHERYL A. MCCLAIN M.D. |
| Provider Location Address | 340 LEGION DR STE 28 LEXINGTON, KY 40504 |
| Provider Mailing Address | 615 ELSINORE PL STE 200 CINCINNATI, OH 45202 |
| Gender | Female |
| NPI Entity Type | Individual |
| Medical School Name | UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE |
| Graduation Year | 1995 |
| Is Sole Proprietor? | Yes |
| Is Organization Subpart? | N/A |
| Enumeration Date | 07-17-2006 |
| Last Update Date | 05-13-2021 |
Primary Taxonomy
| Taxonomy Code | 207RA0401X |
| Classification | Internal Medicine |
| Type | Allopathic & Osteopathic Physicians |
| Specialization | Addiction Medicine |
| License No. | 32948 |
| License State | KY |
| Taxonomy Description | An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. |
Business Address
CHERYL A. MCCLAIN M.D.
340 LEGION DR STE 28
LEXINGTON, KY
ZIP 40504
Phone: (513) 834-7063
Mailing Address
CHERYL A. MCCLAIN M.D.
615 ELSINORE PL STE 200
CINCINNATI, OH
ZIP 45202
Phone: (513) 834-7063
Secondary Locations
Morehead, KY 40351
(606) 784-3771
London, KY 40741
(606) 712-0043
Louisville, KY 40272
(502) 749-6249
Georgetown, KY 40324
(502) 868-7272
Medicare Participation
What is PECOS?
PECOS is the Medicare Provider, Enrollment, Chain and Ownership System. PECOS is Medicare's enrollment and revalidation system and it is the primary source of information about verified Medicare professionals. A NPI number is necessary to register in PECOS. Providers must enroll in PECOS to avoid denied claims.
| Registered in PECOS? | Yes |
| PECOS PAC ID | 9133026594 |
| PECOS Enrollment ID | I20161006001577 |
| 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 / refer Durable Medical Equipment | Yes |
| Eligible order / refer Home Health Agency (HHA) | Yes |
| Eligible order / 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 40504 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 |
| $54.72 | $168.41 | $127.37 |
| Minimum New Patient Copayment | Maximum New Patient Copayment | Typical New Patient Copayment |
| $13.68 | $42.1 | $31.84 |
| Established Patients Office Visits Costs * | ||
|---|---|---|
| Most Utilized Procedure Code for established patients office visits: 99211 | ||
| Minimum Established Patient Pricing | Maximum Established Patient Pricing | Typical Established Patient Pricing |
| $16.65 | $137.34 | $16.65 |
| Minimum Established Patient Copayment | Maximum Established Patient Copayment | Typical Established Patient Copayment |
| $4.16 | $34.33 | $4.16 |
* 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% | 100 | |
|
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 (PI) | 25% | 67.3 | |
|
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. |
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| 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. |
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| 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. |
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| MIPS Final Score | - | 94.2 | |
| 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. | |||
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.
- 133Administration of pneumococcal vaccine (HCPCS:G0009)
- 129Pneumococcal vaccine for injection into muscle (HCPCS:90670)
- 125Urinalysis, manual test (HCPCS:81002)
- 118Administration of influenza virus vaccine (HCPCS:G0008)
- 114Injection, triamcinolone acetonide, not otherwise specified, 10 mg (HCPCS:J3301)
- 106Injection beneath the skin or into muscle for therapy, diagnosis, or prevention (HCPCS:96372)
- 73Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounter (HCPCS:G0434)
- 62Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit (HCPCS:G0439)
- 53Routine EKG using at least 12 leads including interpretation and report (HCPCS:93000)
- 48Blood glucose (sugar) test performed by hand-held instrument (HCPCS:82962)
- 13Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imple (HCPCS:G0180)
Secondary Taxonomies
The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.
| No. | Taxonomy Code | Type | Classification | Specialization | License No. | State | Primary |
|---|---|---|---|---|---|---|---|
| 1 | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | 32948 | KY | No | |
Taxonomy Description: family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. | |||||||
Additional Identifiers
Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State |
|---|---|---|
| 64329485 | MEDICAID (05) | KY |
| 4000501 | OTHER (01) | KY |
| CB5773 | OTHER (01) | |
| 080161176 | OTHER (01) | |
| 37903705 | OTHER (01) | KY |
Other Providers at the same location
The following 13 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1912395658 | MS. JEANA BINGHAM MSW Individual | Counselor (Addiction (Substance Use Disorder)) | 340 LEGION DR STE 28 LEXINGTON, KY 40504 (859) 276-0533 |
| 1750428363 | CARLA MORSE Individual | Counselor (Addiction (Substance Use Disorder)) | 340 LEGION DR STE 28 LEXINGTON, KY 40504 (859) 276-0533 |
| 1174912208 | MICHELLE CASSITY BS Individual | Counselor (Addiction (Substance Use Disorder)) | 340 LEGION DR STE 28 LEXINGTON, KY 40504 (859) 276-0533 |
| 1588029003 | CHRISTINE FAY STEPHENS MS, CRC Individual | Counselor (Addiction (Substance Use Disorder)) | 340 LEGION DR STE 28 LEXINGTON, KY 40504 (859) 276-0533 |
| 1063877470 | JOHN FERGUSON MS Individual | Counselor (Addiction (Substance Use Disorder)) | 340 LEGION DR STE 28 LEXINGTON, KY 40504 (859) 276-0533 |
| 1598139842 | ELENA BAKER APRN Individual | Nurse Practitioner | 340 LEGION DR STE 28 LEXINGTON, KY 40504 (513) 834-7063 |
| 1538657499 | ALLISON HASTE MSW, CSW Individual | Social Worker | 340 LEGION DR STE 28 LEXINGTON, KY 40504 (513) 834-7063 |
| 1578077509 | BRIGHTVIEW LLC Organization | Internal Medicine (Addiction Medicine) | 340 LEGION DR STE 28 LEXINGTON, KY 40504 (859) 475-3846 |
| 1699163022 | GARY SANTANA MS/CADC Individual | Counselor (Addiction (Substance Use Disorder)) | 340 LEGION DR STE 28 LEXINGTON, KY 40504 (859) 276-0533 |
| 1114376407 | REBECCA KERR LCSW Individual | Social Worker | 340 LEGION DR STE 28 LEXINGTON, KY 40504 (513) 834-7063 |
| 1508222316 | ULLANDA DOUGLAS LPCC Individual | Counselor (Professional) | 340 LEGION DR STE 28 LEXINGTON, KY 40504 (513) 834-7063 |
| 1972653772 | MR. CHARLES R NELTON LPCC Individual | Counselor (Professional) | 340 LEGION DR STE 28 LEXINGTON, KY 40504 (513) 834-7063 |
| 1790283869 | MISS SPENCER DANIELLE SEESE LMFT Individual | Marriage & Family Therapist | 340 LEGION DR STE 28 LEXINGTON, KY 40504 (513) 834-7063 |
NPI Footnotes
What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.
Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date
The date that a NPI record was last updated or changed.
Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.