JOHN CHARLES GILPIN DPT
NPI 1336631605
Physical Therapist in Hixson, TN


Quality Rating: 96.66 out of 100 score

NPI Status: Active since June 03, 2018

Contact Information

1790 HAMILL RD
HIXSON, TN
ZIP 37343
Phone: (423) 362-4378

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  • Individual
  • Male
  • Years of Experience 8
  • Physical Therapist
  • Accepts Insurance
  • Accepts Medicare Approved Payment

About JOHN GILPIN

This page provides the complete NPI Profile along with additional information for John Gilpin, a provider established in Hixson, Tennessee with a medical specialization in Physical Therapist and more than 8 years of experience. The healthcare provider is registered in the NPI registry with number 1336631605 assigned on June 2018. The practitioner's primary taxonomy code is 225100000X. The provider is registered as an individual and his NPI record was last updated 7 years ago.

NPI
1336631605
Provider Name
JOHN CHARLES GILPIN DPT
Gender
Male
Entity Type
Individual
Location Address
1790 HAMILL RD HIXSON, TN 37343
Location Phone
(423) 362-4378
Mailing Address
1790 HAMILL RD HIXSON, TN 37343
Mailing Phone
(423) 362-4381
Medical School Name
OTHER
Graduation Year
2018
Is Sole Proprietor?
No
Enumeration Date
06-03-2018
Last Update Date
06-08-2018
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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

Physical Therapist

Taxonomy Code
225100000X
Type
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Description
Physical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles. PTs:
  • Diagnose and manage movement dysfunction and enhance physical and functional abilities.
  • Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.
  • Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.
  • Treat conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems.
  • Address the negative effects attributable to unique personal and environmental factors as they relate to human performance.
PTs provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a PT practices.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Bronze 2 Advanced HSA: Aetna network + MinuteClinic + Virtual Primary Care - HMO
  • Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
  • Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision - HMO
  • Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
  • Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
  • Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision - HMO
  • Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
  • Gold 3 Advanced: Aetna network + $0 MinuteClinic + Adult Dental + Vision - HMO
  • Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
  • Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
  • Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision - HMO
  • Silver 5 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
  • Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
  • Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Adult Dental+Vision - HMO
  • SoloCare Bronze EPO HDHP 8050 10004 - EPO
  • SoloCare Exp Bronze EPO 7200 - $0 Generic Rx 10015 - EPO
  • SoloCare Gold EPO 2300 - 3 Free PCP Visits, $5 Generic Rx 10010 - EPO
  • SoloCare Silver EPO 6000/60 - 3 Free PCP Visits 10014 - EPO
  • SoloCare Silver EPO 7000 - 3 Free PCP Visits, $5 Generic Rx 10013 - EPO
  • SoloCare Standard Exp Bronze EPO 10008 - EPO
  • SoloCare Standard Gold EPO 10006 - EPO
  • SoloCare Standard Platinum EPO 10005 - EPO
  • SoloCare Standard Silver EPO 10007 - EPO
  • BlueCross B07S HSA - EPO
  • BlueCross B15S $0 virtual care from Teladoc Health � - EPO
  • BlueCross B16S $50 PCP Copay + $0 virtual care from Teladoc Health � - EPO
  • BlueCross B17S $0 virtual care from Teladoc Health � + Adult Dental - EPO
  • BlueCross G06S $35 PCP Copay + $0 virtual care from Teladoc Health � - EPO
  • BlueCross G08S $30 PCP Copay + $0 virtual care from Teladoc Health � - EPO
  • BlueCross S25S $55 PCP Copay + $0 virtual care from Teladoc Health � - EPO
  • BlueCross S26S $40 PCP Copay + $0 virtual care from Teladoc Health � - EPO
  • BlueCross S27S $60 PCP Copay + $0 virtual care from Teladoc Health � - EPO
  • BlueCross S29S $60 PCP Copay + $0 virtual care from Teladoc Health � + Adult Dental - EPO
  • Connect Bronze 3500 Indiv Med Deductible Enhanced Diabetes Care - EPO
  • Connect Bronze 7500 Indiv Med Deductible - EPO
  • Connect Bronze 8500 Indiv Med Deductible - EPO
  • Connect Bronze CMS Standard - EPO
  • Connect Gold CMS Standard - EPO
  • Connect Silver 2500 Indiv Med Deductible Enhanced Diabetes Care - EPO
  • Connect Silver 2875 Indiv Med Deductible - EPO
  • Connect Silver 3825 Indiv Med Deductible - EPO
  • Connect Silver CMS Standard - EPO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Medicare Participation & PECOS Enrollment Status

John Gilpin 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.

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.

  • PECOS PAC ID: 2062766462

    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: I20181124000096

    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.

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.

Evaluation for physical therapy, typically 20 minutes

An evaluation for physical therapy is a short, 20-minute assessment where your physical condition, mobility, and pain levels are examined. This helps in designing a personalized therapy plan to enhance your physical function and well-being.

This service was performed 13 times for 13 patients

Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes

This therapy helps retrain your brain, nerves, and muscles to work together. Through targeted exercises, your body learns to regain lost functions or improve current abilities. Each session lasts 15 minutes.

This service was performed 63 times for 16 patients

Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes

This therapy involves exercises to boost strength, endurance, flexibility, and range of motion. Each session lasts 15 minutes. The goal is to improve physical function and overall health. It's a safe, beneficial method for enhancing well-being and fitness.

This service was performed 358 times for 34 patients

Therapy procedure using functional activities

A therapy procedure using functional activities encourages you to use your own body movements in day-to-day tasks to aid recovery. It aims to improve your mobility, strength, and overall health by incorporating therapeutic exercises into your routine.

This service was performed 67 times for 17 patients

Therapy procedure using manual technique, each 15 minutes

This therapy involves using hands-on techniques to help improve your body's movement and function. These techniques may include stretching, resistance exercises, or gentle pressure. Each session lasts 15 minutes and aims to relieve pain, promote healing, and improve your overall health.

This service was performed 190 times for 28 patients

Physician Visit Costs



The typical physician office visit costs for Medicare beneficiaries in this area are: $20.38 for a new patient copayment and $16.5 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 37343 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

  • Average New Patient Price $81.53
  • Minimum New Patient Price $52.64
  • Maximum New Patient Price $160.89
  • Average New Patient Copayment $20.38
  • Minimum New Patient Copayment $13.16
  • Maximum New Patient Copayment $40.22

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

  • Average Established Patient Price $66.01
  • Minimum Established Patient Price $16.72
  • Maximum Established Patient Price $131.41
  • Average Established Patient Copayment $16.5
  • Minimum Established Patient Copayment $4.18
  • Maximum Established Patient Copayment $32.85

* 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 96.66, 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.

  • Final Score: 96.66 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.

  • Quality Score: 87.09

    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 Score: 99

    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: 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.

  • Cost Score: 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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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.
1336631605
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2366123260
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 3 + 6 + 6 + 1 + 2 + 3 + 2 + 6 + 0 + 24 = 55
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 55 = 55

The NPI number 1336631605 is valid because the calculated check digit 5 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.

TIMOTHY DANIEL DOTSON DPT

Physical Therapist

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 771-4600

DAVID MICHAEL DRAPER P.T.

Physical Therapist

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 842-9322

JANICE ADCOCK PT

Physical Therapist

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 771-4600

MATTHEW V PROVENZANO PT

Physical Therapist

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 771-4600

MS. REBECCA LYNN PETTICORD OT

Occupational Therapist

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 842-9322

ANGELA CROSS

Physical Therapist

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 842-9322

MR. STEVEN ASBURY DPT

Physical Therapist

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 842-9322

MRS. MOLLY M. CONNOLLY SPTL

Speech-Language Pathologist

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 842-9322

ETHAN BRAYTENBAH

Physical Therapist

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 842-9322

MR. SAMUEL ROBERT BACHMAN

Physical Therapist

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 842-9322

KEVIN KOSTKA P.T.

Physical Therapist

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 842-9322

NICHOLAS FEIRA DPT

Physical Therapist

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 842-9322

LINDSEY L SWINSON OT

Occupational Therapy Assistant

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 842-9322

MR. WILLIAM THOMAS PAYNE OTR/L

Occupational Therapist

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 385-4772

DR. BRIAN PORBANSKY PT, DPT

Physical Therapist

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 362-4381

MALCOLM N COLBERT III P.T.

Physical Therapist

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 362-4381

EMILY ALLWINE

Physical Therapist

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 842-9322

GABRIELLE GRANT DPT

Physical Therapist

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 842-9322

SUMMIT PHYSICAL THERAPY, LLC

Clinic/Center

(Physical Therapy)

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 842-9322

KAITLIN KREMINSKI PT, DPT

Physical Therapist

1790 HAMILL RD
HIXSON, TN
ZIP 37343

(423) 842-9322

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1336631605, enumerated as an "individual" on June 03, 2018.

The provider is located at 1790 HAMILL RD HIXSON, TN 37343 and the phone number is (423) 362-4378.

Physical Therapist with taxonomy code 225100000X.

The provider might be accepting Accepts: Aetna CVS Health, Alliant Health Plans, Inc.,. Please consult your insurance carrier or call the provider to verify.