DR. PHILIP SIMKOVITZ MD
NPI 1346358744
Internal Medicine - Critical Care Medicine in Trumbull, CT

PECOS Enrollment and Medicare Participation Status

Philip Simkovitz 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: 9537108345

  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: I20050502000444

  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)

  Tubing with integrated heating element for use with positive airway pressure device (HCPCS:A4604)

  8 DME suppliers used 132 Medicare Claims 132 Services Paid

• Other DME (D1E)

  Administration set, with small volume nonfiltered pneumatic nebulizer, disposable (HCPCS:A7003)

  4 DME suppliers used 54 Medicare Claims 119 Services Paid

• Other DME (D1E)

  Small volume nonfiltered pneumatic nebulizer, disposable (HCPCS:A7004)

  2 DME suppliers used 16 Medicare Claims 32 Services Paid

• Other DME (D1E)

  Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable (HCPCS:A7005)

  5 DME suppliers used 18 Medicare Claims 18 Services Paid

• Other DME (D1E)

  Filter, nondisposable, used with aerosol compressor or ultrasonic generator (HCPCS:A7014)

  3 DME suppliers used 11 Medicare Claims 11 Services Paid

• Other DME (D1E)

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

  6 DME suppliers used 121 Medicare Claims 121 Services Paid

• Other DME (D1E)

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

  5 DME suppliers used 121 Medicare Claims 344 Services Paid

• Other DME (D1E)

  Cushion for use on nasal mask interface, replacement only, each (HCPCS:A7032)

  6 DME suppliers used 46 Medicare Claims 271 Services Paid

• Other DME (D1E)

  Pillow for use on nasal cannula type interface, replacement only, pair (HCPCS:A7033)

  4 DME suppliers used 33 Medicare Claims 197 Services Paid

• Other DME (D1E)

  Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap (HCPCS:A7034)

  7 DME suppliers used 82 Medicare Claims 82 Services Paid

• Other DME (D1E)

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

  9 DME suppliers used 112 Medicare Claims 112 Services Paid

• Other DME (D1E)

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

  7 DME suppliers used 67 Medicare Claims 67 Services Paid

• Other DME (D1E)

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

  10 DME suppliers used 194 Medicare Claims 1097 Services Paid

• Other DME (D1E)

  Filter, non disposable, used with positive airway pressure device (HCPCS:A7039)

  4 DME suppliers used 52 Medicare Claims 52 Services Paid

• Other DME (D1E)

  Water chamber for humidifier, used with positive airway pressure device, replacement, each (HCPCS:A7046)

  6 DME suppliers used 82 Medicare Claims 82 Services Paid

• Oxygen and supplies (D1C)

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

  3 DME suppliers used 139 Medicare Claims 148 Services Paid

• Other DME (D1E)

  Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) (HCPCS:E0466)

  2 DME suppliers used 20 Medicare Claims 22 Services Paid

• Other DME (D1E)

  Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) (HCPCS:E0470)

  2 DME suppliers used 17 Medicare Claims 19 Services Paid

• Other DME (D1E)

  High frequency chest wall oscillation system, includes all accessories and supplies, each (HCPCS:E0483)

  2 DME suppliers used 25 Medicare Claims 25 Services Paid

• Other DME (D1E)

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

  1 DME suppliers used 109 Medicare Claims 109 Services Paid

• Other DME (D1E)

  Nebulizer, with compressor (HCPCS:E0570)

  6 DME suppliers used 158 Medicare Claims 161 Services Paid

• Other DME (D1E)

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

  4 DME suppliers used 132 Medicare Claims 141 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)

  7 DME suppliers used 245 Medicare Claims 259 Services Paid

• Oxygen and supplies (D1C)

  Portable oxygen concentrator, rental (HCPCS:E1392)

  3 DME suppliers used 28 Medicare Claims 28 Services Paid

• Drugs Administered through DME (D1G)

  Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms (HCPCS:J7605)

  3 DME suppliers used 22 Medicare Claims 1680 Services Paid

• Drugs Administered through DME (D1G)

  Formoterol fumarate, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 20 micrograms (HCPCS:J7606)

  4 DME suppliers used 37 Medicare Claims 2220 Services Paid

• Drugs Administered through DME (D1G)

  Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg (HCPCS:J7613)

  5 DME suppliers used 19 Medicare Claims 5060 Services Paid

• Drugs Administered through DME (D1G)

  Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme (HCPCS:J7620)

  16 DME suppliers used 144 Medicare Claims 15591 Services Paid

• Drugs Administered through DME (D1G)

  Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg (HCPCS:J7626)

  11 DME suppliers used 127 Medicare Claims 8854 Services Paid

• Drugs Administered through DME (D1G)

  Revefenacin inhalation solution, fda-approved final product, non-compounded, administered through dme, 1 microgram (HCPCS:J7677)

  2 DME suppliers used 11 Medicare Claims 68250 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)

  3 DME suppliers used 69 Medicare Claims 74 Services Paid

Drugs and Nutritional Products

• Other drugs (O1E)

  Pharmacy dispensing fee for inhalation drug(s); per 30 days (HCPCS:Q0513)

  15 DME suppliers used 196 Medicare Claims 196 Services Paid

• Other drugs (O1E)

  Pharmacy dispensing fee for inhalation drug(s); per 90 days (HCPCS:Q0514)

  5 DME suppliers used 11 Medicare Claims 11 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 06611 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.

Overall MIPS Quality 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: 86.04 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: 85.13

  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: 78.26

  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.

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.

• 312

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

• 219

  Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration (HCPCS:94060)

• 118

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

• 118

  Measurement of lung diffusing capacity (HCPCS:94729)

• 53

  X-ray of chest, 2 views (HCPCS:71046)

• 42

  Administration of influenza virus vaccine (HCPCS:G0008)

• 29

  Test for exercise-induced lung stress (HCPCS:94618)

• 11

  Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort (HCPCS:95806)

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. Philip Simkovitz is affiliated with the following medical facilities:

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number

07D0711156

Facility Type

Physician Office

Certificate Effective Date

September 01, 2022

Certificate Expiration Date

August 31, 2024

Certificate Type

Certificate of Waiver

Certificate Type Description

This CLIA certificate is issued to Philip Simkovitz to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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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.

The NPI number 1346358744 is valid because the calculated check digit 4 using the Luhn validation algorithm matches the last digit of the original NPI number.

Frequently Asked Questions