THOMAS A OTTER MD
NPI 1346240876
Orthopaedic Surgery in Lewes, DE

NPI Status: Active since July 27, 2005

Contact Information

17005 OLD ORCHARD RD
LEWES, DE
ZIP 19958
Phone: (302) 644-3311
Fax: (302) 644-3300

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Quality Reporting
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Male
Orthopaedic Surgery
Medicare Quality Reporting

About THOMAS OTTER

This page provides the complete NPI Profile along with additional information for Thomas Otter, a provider established in Lewes, Delaware with a medical specialization in Orthopaedic Surgery. The healthcare provider is registered in the NPI registry with number 1346240876 assigned on July 2005. The practitioner's primary taxonomy code is 207X00000X with license number C10008890 (DE). The provider is registered as an individual and his NPI record was last updated 7 years ago.

NPI: 1346240876
Provider Name: THOMAS A OTTER MD
Gender: Male
Entity Type: Individual
Location Address: 17005 OLD ORCHARD RD LEWES, DE 19958
Location Phone: (302) 644-3311
Location Fax: (302) 644-3300
Mailing Address: 211 EXECUTIVE DR STE 11 NEWARK, DE 19702
Mailing Phone: (302) 451-6913
Mailing Fax: (302) 644-3300
Is Sole Proprietor?: No
Enumeration Date: 07-27-2005
Last Update Date: 02-15-2019
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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: Orthopaedic Surgery
Taxonomy Code: 207X00000X
Type: Allopathic & Osteopathic Physicians
License No.: C10008890
License State: DE
Taxonomy Description: An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.

Insurance Plans Accepted

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

AmeriHealth

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Blue Cross Blue Shield

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Railroad Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Cigna

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Aetna

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Tricare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

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

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	Identifier Issuer
3692762000	OTHER (01)	DE	AMERIHEALTH
510370286	OTHER (01)		MULTIPLAN, INC.
1346240876	OTHER (01)		CREENAGHT HEALTH PLAN
510370286	OTHER (01)		PRIVATE HEALTHCARE SYSTEMS
1346240876	MEDICAID (05)	DE
510370286	OTHER (01)		UNION LABOR LIFE INSURANCE COMPANY
510370286	OTHER (01)	DE	DEVON HEALTH SERVICES
510370286	OTHER (01)		BLUE CROSS BLUE SHIELD OF DELAWARE
510370286	OTHER (01)		EASTERN SUSSEX PHYSICIAN ORGANIZATION, P.A. (ESPO)
P00712879	OTHER (01)		RAILROAD MEDICARE
510370286	OTHER (01)	DE	CIGNA
510370286	OTHER (01)		UNITED HEALTHCARE
264933	OTHER (01)		UNISON HEALTH PLAN
510370286	OTHER (01)		CORVEL CORPORATION
1346240876	OTHER (01)		COMMUNITY HEALTH PLAN
4056337	OTHER (01)	DE	AETNA US HEALTHCARE
510370286	OTHER (01)	DE	PERDUE FARMS, INC.
510370286	OTHER (01)		ONE NET PPO
510370286	OTHER (01)		HEALTH NET FEDERAL SERVICES / TRICARE
1346240876	OTHER (01)		NATIONAL CAPITAL PPO
510370286	OTHER (01)		OPTIMUM CHOICE
510370286	OTHER (01)		M.D. IPA
1346240876	OTHER (01)		DELAWARE PHYSICIANS CARE, INC.
510370286	OTHER (01)		GREAT WEST HEALTHCARE
510370286	OTHER (01)		MAMSI

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.

Quality Measure	Performance	Number of Patients
Annual registration in the Prescription Drug Monitoring Program	Yes	N/A
Annual registration by eligible clinician or group in the prescription drug monitoring program of the state where they practice. Activities that simply involve registration are not sufficient. MIPS eligible clinicians and groups must participate for a minimum of 6 months.
Closing the Referral Loop: Receipt of Specialist Report	98%	41
Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred
Diabetes: Medical Attention for Nephropathy	68%	31
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
Documentation of Current Medications in the Medical Record	100%	2796
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration
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.
e-Prescribing	93%	73
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Health Information Exchange	100%	35
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for at least one transition of care or referral.
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.
Medication Reconciliation	99%	1287
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
Patient-Specific Education	98%	1190
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
Pneumococcal Vaccination Status for Older Adults	59%	592
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
Practice Improvements for Bilateral Exchange of Patient Information	Yes	N/A
Ensure that there is bilateral exchange of necessary patient information to guide patient care, such as Open Notes, that could include one or more of the following: • Participate in a Health Information Exchange if available; and/or • Use structured referral notes.
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	90%	699
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
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.
Provide Patient Access	66%	1187
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information.
Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms.	Yes	N/A
Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms.
Secure Messaging	0%	1187
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period.
Security Risk Analysis	Yes	N/A
Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.
Use of High-Risk Medications in the Elderly	0% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better.	592
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication. 2) Percentage of patients who were ordered at least two of the same high-risk medication

NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1346240876, we treat the final digit (6) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 64. The final step is to find the difference between that total and the next multiple of ten (70 - 64 = 6).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 8

Pos 4

Unchanged

Pos 5

Doubled → 4

Pos 6

Unchanged

Pos 7

Doubled → 0

Pos 8

Unchanged

Pos 9

Doubled → 14 → 1 + 4

Check

Target digit

Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 4 → 8 2 → 4 0 → 0 7 → 14 → 5

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 3 + 8 + 6 + 4 + 4 + 0 + 8 + 1 + 4 + 24 = 64

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 64 is 70. The difference is the calculated check digit.

70 - 64 = 6

This NPI is valid

The calculated check digit is 6, which matches the last digit of 1346240876.