DR. RAUL MAGADIA MD NPI 1326015231
Internal Medicine - Infectious Disease in Anniston, AL
About DR. RAUL MAGADIA MD
Raul Magadia is an internist established in Anniston, Alabama and his medical specialization is Internal Medicine with a focus in infectious disease with more than 30 years of experience. The NPI number of this provider is 1326015231 and was assigned on March 2006. The practitioner's primary taxonomy code is 207RI0200X with license number 26338 (AL). The provider is registered as an individual and his NPI record was last updated 14 years ago.
|Provider Name||DR. RAUL MAGADIA MD|
|Location Address||1112 CHRISTINE AVE ANNISTON, AL 36207|
|Location Phone||(256) 237-2351|
|Mailing Address||40 GILES ST HEFLIN, AL 36264|
|NPI Entity Type||Individual|
|Medical School Name||OTHER|
|Is Sole Proprietor?||No|
|Last Update Date||01-06-2009|
An internist like Raul Magadia 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.Raul Magadia 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.
Raul Magadia 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. According to Medicare claims data he has hospital affiliations with .
The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 45, 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: $32.26 for a new patient copayment and $24.83 for an established patient copayment.
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.
|Type||Allopathic & Osteopathic Physicians|
|Taxonomy Description||An internist who deals with infectious diseases of all types and in all organ systems. Conditions requiring selective use of antibiotics call for this special skill. This physician often diagnoses and treats AIDS patients and patients with fevers which have not been explained. Infectious disease specialists may also have expertise in preventive medicine and travel medicine.|
The NPI profile data indicates this provider might be enrolled and accepting health plans from the following insurance companies or healthcare programs:
- Railroad Medicare
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
1112 CHRISTINE AVE
Phone: (256) 237-2351
Fax: (256) 237-2350
40 GILES ST
Phone: (256) 237-2351
Fax: (256) 237-2350
PECOS Enrollment and Medicare Participation Status
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||547240954|
|PECOS Enrollment ID||I20050216000951|
|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 36207 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|
|Minimum New Patient Copayment||Maximum New Patient Copayment||Typical New Patient Copayment|
|Established Patients Office Visits Costs *|
|Most Utilized Procedure Code for established patients office visits: 99214|
|Minimum Established Patient Pricing||Maximum Established Patient Pricing||Typical Established Patient Pricing|
|Minimum Established Patient Copayment||Maximum Established Patient Copayment||Typical Established Patient Copayment|
* 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|
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%||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.
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.
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||-||45|
|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.|
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.
- 656Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour (HCPCS:96365)
- 160Removal of skin and tissue first 20 sq cm or less (HCPCS:11042)
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||Identifier Issuer|
|P00219363||OTHER (01)||AL||RAILROAD MEDICARE ID|
|1104891241||OTHER (01)||AL||GROUP NPI|
|H91641||MEDICARE UPIN (02)||AL|
|051526130||MEDICARE ID-TYPE UNSPECIFIED (04)||AL||MEDICARE PROVIDER NUMBER|
|DB8444||OTHER (01)||AL||RAILROAD GROUP NUMBER|
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.|
|Step 1: Double the value of the alternate digits, beginning with the rightmost digit.|
|Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.|
|2 + 3 + 4 + 6 + 0 + 1 + 1 + 0 + 2 + 6 + 24 = 49|
|Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.|
|50 - 49 = 1||1|
The NPI number 1326015231 is valid because the calculated check digit 1 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 3 providers are registered at the same or nearby location.
|NPI||Name / Type||Taxonomy||Address|
|1770631525|| ANDREJS ANDREJS TRENINS M.D. |
|Internal Medicine||1112 CHRISTINE AVE |
ANNISTON, AL 36207
|1609897503||MR. MUZAMIL E. BABIKER MD |
|Internal Medicine||1112 CHRISTINE AVE |
ANNISTON, AL 36207
|1457429516||CLEBURNE MEDICAL CLINIC |
|Clinic/Center (Primary Care)||1112 CHRISTINE AVE |
ANNISTON, AL 36207
Frequently Asked Questions
What is Dr. Raul Magadia MD NPI number?
The NPI number assigned to this healthcare provider is 1326015231, registered as an "individual" on March 01, 2006
Where is Dr. Raul Magadia MD located?
The provider is located at 1112 Christine Ave Anniston, Al 36207 and the phone number is (256) 237-2351
Which is Dr. Raul Magadia MD specialty?
The provider's speciality is Internal Medicine with a focus in Infectious Disease
How many years of experience does Dr. Raul Magadia MD have?
The provider has more than 30 years of experience.
What insurance does Dr. Raul Magadia MD accept?
The provider might be accepting Medicaid, Medicare and Railroad Medicare. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Is Dr. Raul Magadia MD registered in PECOS?
Yes, as of March 13, 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.
How much is a visit to Dr. Raul Magadia MD?
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.
What are some of the services provided by Dr. Raul Magadia MD?
The most common procedures or services performed by this practitioner are: Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour and Removal of skin and tissue first 20 sq cm or less.
How do I update my NPI information?
The NPI record of Dr. Raul Magadia MD was last updated on March 01, 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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