DR. MIKHAIL I. RAKHMANINE M.D.
NPI 1326028705
Colon & Rectal Surgery in Allentown, PA

Medicare Participation & PECOS Enrollment Status

Mikhail Rakhmanine 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.

Mikhail Rakhmanine 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: 1951359942

  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: I20060531000164

  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

Provider Referred Orders for Durable Medical Equipment, Devices & Supplies

The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.

Orthotic Devices

• DME-Orthotic Devices (DF010N)

  Skin barrier; solid, 4 x 4 or equivalent; each (HCPCS:A4362)

  5 DME suppliers used 15 Medicare Claims 460 Services Paid

• DME-Orthotic Devices (DF010N)

  Ostomy skin barrier, powder, per oz (HCPCS:A4371)

  4 DME suppliers used 14 Medicare Claims 24 Services Paid

• DME-Orthotic Devices (DF010N)

  Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each (HCPCS:A4373)

  2 DME suppliers used 11 Medicare Claims 140 Services Paid

• DME-Orthotic Devices (DF010N)

  Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each (HCPCS:A4385)

  7 DME suppliers used 29 Medicare Claims 980 Services Paid

• DME-Orthotic Devices (DF010N)

  Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce (HCPCS:A4394)

  5 DME suppliers used 22 Medicare Claims 337 Services Paid

• DME-Orthotic Devices (DF010N)

  Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each (HCPCS:A4407)

  5 DME suppliers used 29 Medicare Claims 600 Services Paid

• DME-Orthotic Devices (DF010N)

  Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each (HCPCS:A4409)

  6 DME suppliers used 23 Medicare Claims 810 Services Paid

• DME-Orthotic Devices (DF010N)

  Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each (HCPCS:A4414)

  3 DME suppliers used 17 Medicare Claims 565 Services Paid

• DME-Orthotic Devices (DF010N)

  Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each (HCPCS:A4419)

  2 DME suppliers used 35 Medicare Claims 2370 Services Paid

• DME-Orthotic Devices (DF010N)

  Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each (HCPCS:A4425)

  7 DME suppliers used 38 Medicare Claims 970 Services Paid

• DME-Orthotic Devices (DF010N)

  Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each (HCPCS:A5063)

  4 DME suppliers used 14 Medicare Claims 500 Services Paid

• DME-Orthotic Devices (DF010N)

  Skin barrier, wipes or swabs, each (HCPCS:A5120)

  7 DME suppliers used 24 Medicare Claims 1136 Services Paid

Durable Medical Equipment

• DME-Medical/Surgical Supplies (DA000N)

  Adhesive remover, wipes, any type, each (HCPCS:A4456)

  7 DME suppliers used 24 Medicare Claims 1680 Services Paid

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.

Biopsy of large bowel using a flexible endoscope

A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.

This service was performed 43 times for 43 patients

Biopsy of lower large bowel using a flexible endoscope

A biopsy of the lower large bowel involves using a flexible tube with a camera (endoscope) to examine this part of your digestive tract. Small tissue samples may be taken for further examination to detect any abnormalities.

This service was performed 12 times for 11 patients

Colonoscopy

A colonoscopy is a medical procedure that allows your doctor to examine your colon (the large intestine). It utilizes a thin, flexible tube with a tiny camera on the end, which is inserted through the rectum. This procedure can help identify issues such as polyps, inflammation, or early signs of cancer. It's usually recommended for people over 50 or those with specific risk factors.

This service was performed for 296 patients

Colorectal cancer screening; colonoscopy on individual at high risk

Colorectal cancer screening, specifically a colonoscopy, is a preventive measure for those at high risk. A thin, flexible tube with a camera inspects the colon to spot any abnormal growths. This test helps detect potential issues early, enhancing the effectiveness of treatment.

This service was performed 61 times for 61 patients

Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk

Colorectal cancer screening, such as a colonoscopy, is a preventive measure to detect early signs of cancer in the large intestine. For individuals not at high risk, it's typically recommended at age 50. A small, flexible tube with a camera is used to examine your colon. It's a safe, effective way to catch issues early.

This service was performed 19 times for 19 patients

Diagnostic exam of posterior opening using an endoscope

This procedure involves using a thin, flexible instrument called an endoscope to examine the posterior opening area. It helps detect any abnormal conditions or issues. It's a safe, routine exam performed by a healthcare professional.

This service was performed 77 times for 71 patients

Diagnostic exam of large bowel using a flexible endoscope

This procedure, known as a colonoscopy, involves using a flexible tube with a light and camera to examine the large intestine. It helps detect any abnormalities such as polyps or inflammation. It's a standard procedure to ensure gut health.

This service was performed 14 times for 14 patients

Diagnostic exam of lower portion of large bowel using a flexible endoscope

This procedure, known as a sigmoidoscopy, involves using a flexible tube with a camera to examine the lower part of your large bowel. It helps in identifying issues like inflammation, ulcers, or abnormal growths. It's a safe, minimally invasive procedure.

This service was performed 36 times for 32 patients

Electronic analysis of implanted neurostimulator generator with complex spinal cord or peripheral nerve stimulator programming

This procedure involves electronically analyzing an implanted neurostimulator. This device sends electrical pulses to your spinal cord or peripheral nerves to manage pain. The programming is complex, requiring expert analysis to ensure proper functioning.

This service was performed 26 times for 21 patients

Established patient office or other outpatient visit, 20-29 minutes

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

This service was performed 223 times for 197 patients

Established patient office or other outpatient visit, 30-39 minutes

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

This service was performed 87 times for 77 patients

Follow-up hospital inpatient care per day, typically 35 minutes

Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.

This service was performed 101 times for 54 patients

Initial hospital inpatient care per day, typically 50 minutes

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

This service was performed 62 times for 57 patients

Melanoma (skin cancer) excision

Melanoma excision is a procedure where a surgeon removes melanoma, a type of skin cancer, and some surrounding healthy tissue. Local anesthesia is applied to numb the area. The goal is to completely remove the cancer and prevent its spread. Healing time varies.

This service was performed for 1-10 patients

New patient office or other outpatient visit, 30-44 minutes

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

This service was performed 228 times for 228 patients

New patient office or other outpatient visit, 45-59 minutes

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

This service was performed 50 times for 50 patients

Removal of external hemorrhoids by rubber banding

Rubber band ligation is a procedure used to treat external hemorrhoids. A doctor places small rubber bands around the base of the hemorrhoids. This cuts off blood supply, causing them to shrink and fall off, typically within a week.

This service was performed 62 times for 35 patients

Removal of polyps or growths of large bowel using an endoscope with mechanical snare

This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.

This service was performed 264 times for 263 patients

Removal of polyps or growths of lower large bowel using a flexible endoscope with mechanical snare

This procedure involves removing abnormal growths called polyps from the lower part of the large bowel. A flexible tube with a camera, known as an endoscope, is used to view the inside of the bowel. A special tool called a mechanical snare is used to cut and remove the polyps.

This service was performed 14 times for 13 patients

Study of rectum sensitivity and function

This procedure examines the rectum's sensitivity and functionality. It involves a small, soft balloon inserted into the rectum and inflated to various degrees. The goal is to assess how well your rectum can sense and respond to different volumes. It's a crucial test for diagnosing certain digestive issues.

This service was performed 16 times for 16 patients

Test for tone and sensation of rectum and anus

This procedure checks the health of the lower digestive tract. The doctor gently examines the area to assess its muscle strength and sensitivity. This helps in detecting any abnormal conditions. It's a standard, safe procedure with minimal discomfort.

This service was performed 16 times for 16 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $21.22 for a new patient copayment and $17.09 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 18103 ZIP code area.

* 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.

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.

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Mikhail Rakhmanine is affiliated with the following medical facilities:

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