TERRY S WADE D.O.
NPI 1346243516
Family Medicine in Cedaredge, CO

NPI Status: Active since May 23, 2005

Contact Information

255 S GRAND MESA DR
CEDAREDGE, CO
ZIP 81413
Phone: (970) 856-4111
Fax: (970) 856-4114

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  • Individual
  • Male
  • Years of Experience 34
  • Family Medicine
  • PECOS Enrolled
  • Accepts Medicare Approved Payment
  • Medicare Quality Reporting

About TERRY WADE

Terry Wade is a primary care provider established in Cedaredge, Colorado and his medical specialization is Family Medicine with more than 34 years of experience. He graduated from Oklahoma State University College Of Osteopathic Medicine in 1991. The healthcare provider is registered in the NPI registry with number 1346243516 assigned on May 2005. The practitioner's primary taxonomy code is 207Q00000X with license number 32008 (CO). The provider is registered as an individual and his NPI record was last updated 2 years ago.

NPI
1346243516
Provider Name
TERRY S WADE D.O.
Gender
Male
Entity Type
Individual
Location Address
255 S GRAND MESA DR CEDAREDGE, CO 81413
Location Phone
(970) 856-4111
Location Fax
(970) 856-4114
Mailing Address
255 S GRAND MESA DR CEDAREDGE, CO 81413
Mailing Phone
(970) 856-4111
Mailing Fax
(970) 856-4114
Medical School Name
OKLAHOMA STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
Graduation Year
1991
Is Sole Proprietor?
No
Enumeration Date
05-23-2005
Last Update Date
11-01-2022
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A primary care provider (PCP) like Terry Wade sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc

Terry Wade 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.

The provider participated in CMS Quality Payment Program and the following quality measures were reported: use of decision support and standardized treatment protocols. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries.

The typical physician office visit costs for Medicare beneficiaries in this area are: $23.01 for a new patient copayment and $26.58 for an established patient copayment.

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

Family Medicine

Taxonomy Code
207Q00000X
Type
Allopathic & Osteopathic Physicians
License No.
32008
License State
CO
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.

Insurance Plans Accepted

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

  • Cigna

  • Medicare

  • Medicaid

  • Blue Cross Blue Shield

  • Aetna

  • Railroad Medicare


*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
1721506OTHER (01)COCIGNA
119646OTHER (01)COSELECT NET PINNACOL WC
01320084MEDICAID (05)CO 
39326OTHER (01)COCO BLUE CROSS
841452365002OTHER (01)COROCKY MOUNTAIN HEALTH PLA
1421447OTHER (01)COFIRST HEALTH
4703170001OTHER (01)CODMERC SUPPLIER
4087979OTHER (01)TNBLUE CROSS
4361601OTHER (01)COAETNA
080120285OTHER (01)CORAILROAD MEDICARE
1364OTHER (01)BLUE CROSS NASCO

PECOS Enrollment and Medicare Participation Status

Terry Wade 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: 4688573702

    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: I20040107000603

    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.

Durable Medical Equipment

  • Other DME (D1E)

    Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (HCPCS:A4253)

    4 DME suppliers used 38 Medicare Claims 79 Services Paid

  • Other DME (D1E)

    Lancets, per box of 100 (HCPCS:A4259)

    4 DME suppliers used 20 Medicare Claims 20 Services Paid

  • Other DME (D1E)

    Full face mask used with positive airway pressure device, each (HCPCS:A7030)

    3 DME suppliers used 11 Medicare Claims 11 Services Paid

  • Other DME (D1E)

    Face mask interface, replacement for full face mask, each (HCPCS:A7031)

    3 DME suppliers used 17 Medicare Claims 37 Services Paid

  • Other DME (D1E)

    Headgear used with positive airway pressure device (HCPCS:A7035)

    4 DME suppliers used 13 Medicare Claims 13 Services Paid

  • Other DME (D1E)

    Tubing used with positive airway pressure device (HCPCS:A7037)

    3 DME suppliers used 15 Medicare Claims 15 Services Paid

  • Other DME (D1E)

    Filter, disposable, used with positive airway pressure device (HCPCS:A7038)

    4 DME suppliers used 22 Medicare Claims 114 Services Paid

  • Oxygen and supplies (D1C)

    Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing (HCPCS:E0431)

    2 DME suppliers used 45 Medicare Claims 45 Services Paid

  • Other DME (D1E)

    Humidifier, heated, used with positive airway pressure device (HCPCS:E0562)

    1 DME suppliers used 15 Medicare Claims 15 Services Paid

  • Other DME (D1E)

    Continuous positive airway pressure (cpap) device (HCPCS:E0601)

    2 DME suppliers used 24 Medicare Claims 24 Services Paid

  • Oxygen and supplies (D1C)

    Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)

    2 DME suppliers used 201 Medicare Claims 201 Services Paid

  • Oxygen and supplies (D1C)

    Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing (HCPCS:K0738)

    1 DME suppliers used 109 Medicare Claims 109 Services Paid

Physician Visit Costs

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 81413 ZIP code area.

New Patients Visit Costs *

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

  • Average New Patient Price $92.04
  • Minimum New Patient Price $60.06
  • Maximum New Patient Price $181
  • Average New Patient Copayment $23.01
  • Minimum New Patient Copayment $15.01
  • Maximum New Patient Copayment $45.25

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

  • Average Established Patient Price $106.32
  • Minimum Established Patient Price $18.98
  • Maximum Established Patient Price $148.2
  • Average Established Patient Copayment $26.58
  • Minimum Established Patient Copayment $4.74
  • Maximum Established Patient Copayment $37.05

* 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 following quality measures meet Medicare's statistical reporting standards for the year 2018. 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
Use of decision support and standardized treatment protocolsYesN/A
Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs.

Clinician Services

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 2020. The reported codes are based on the top 5 codes for each available specialty, excluding evaluation and management codes.

  • 202

    Injection, triamcinolone acetonide, not otherwise specified, 10 mg (HCPCS:J3301)

  • 91

    Administration of influenza virus vaccine (HCPCS:G0008)

  • 87

    Insertion of needle into vein for collection of blood sample (HCPCS:36415)

  • 85

    Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit (HCPCS:G0439)

  • 81

    Vaccine for influenza for injection into muscle (HCPCS:90662)

  • 55

    Administration of pneumococcal vaccine (HCPCS:G0009)

  • 51

    Injection beneath the skin or into muscle for therapy, diagnosis, or prevention (HCPCS:96372)

  • 41

    Urinalysis, manual test (HCPCS:81002)

  • 37

    Destruction of 2-14 skin growths (HCPCS:17003)

  • 35

    Destruction of skin growth (HCPCS:17000)

Hospital Affiliations

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. Terry Wade is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
DELTA COUNTY MEMORIAL HOSPITAL1501 E 3RD ST
DELTA, CO 81416
(970) 874-7681Acute Care Hospitals

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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.
1346243516
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
238644652
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 3 + 8 + 6 + 4 + 4 + 6 + 5 + 2 + 24 = 64
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 64 = 66

The NPI number 1346243516 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1861083677CEDAR POINT HEALTH LLC
Organization
Family Medicine255 S GRAND MESA DR
CEDAREDGE, CO 81413
(970) 856-4111
1922060656CEDAREDGE DOCTORS OFFICE PC
Organization
Family Medicine255 S GRAND MESA DR
CEDAREDGE, CO 81413
(970) 856-4111

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1346243516, enumerated in the NPI registry as an "individual" on May 23, 2005

The provider is located at 255 S Grand Mesa Dr Cedaredge, Co 81413 and the phone number is (970) 856-4111

The provider's speciality is Family Medicine with taxonomy code 207Q00000X

The provider has more than 34 years of experience. He graduated from Oklahoma State University College Of Osteopathic Medicine in 1991.

The provider might be accepting Accepts: Cigna, Medicare, Medicaid, Blue Cross Blue Shield,. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Yes, as of July 02, 2024 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a 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.

Medicare beneficiaries should expect a typical cost of $92.04 with an average copayment of $23.01 for new patient appointments. Established patients should expect a typical charge of $106.32 and an average copayment of 26.58. Please review your insurance plan or contact the provider directly to determine your specific costs.

The most common procedures or services performed by this practitioner are: Injection, triamcinolone acetonide, not otherwise specified, 10 mg, Administration of influenza virus vaccine, Insertion of needle into vein for collection of blood sample, Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit, Vaccine for influenza for injection into muscle, Administration of pneumococcal vaccine, Injection beneath the skin or into muscle for therapy, diagnosis, or prevention, Urinalysis, manual test, Destruction of 2-14 skin growths and Destruction of skin growth.

The practitioner is affiliated to the following hospital(s): DELTA COUNTY MEMORIAL HOSPITAL. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

This NPI record was last updated on May 23, 2005. 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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