AUSTIN O'SHEA
NPI 1346794930
Physician Assistant - Surgical in Billings, MT

Quality Rating: 94.3 out of 100 score

NPI Status: Active since August 11, 2016

Contact Information

2900 12TH AVE N STE 140W
BILLINGS, MT
ZIP 59101
Phone: (406) 237-5050
Fax: (406) 238-6599

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Table of Contents

NPI Profile Information
Primary Taxonomy
Secondary Taxonomies
Insurance Plans Accepted
Medicare Participation & PECOS Status
Areas of Expertise
Overall Quality Performance
Quality Reporting
Hospital Affiliations - Privileges
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Male
Years of Experience 10
Physician Assistant
Surgical
Accepts Insurance
Accepts Medicare Approved Payment
PECOS Enrolled
Medicare Quality Reporting

About AUSTIN O'SHEA

This page provides the complete NPI Profile along with additional information for Austin O'shea, a provider established in Billings, Montana with a medical specialization in Physician Assistant, focusing in surgical and more than 10 years of experience. The healthcare provider is registered in the NPI registry with number 1346794930 assigned on August 2016. The practitioner's primary taxonomy code is 363AS0400X with license number MED-PAC-LIC-51936 (MT). The provider is registered as an individual and his NPI record was last updated 4 years ago.

NPI: 1346794930
Provider Name: AUSTIN O'SHEA
Gender: Male
Entity Type: Individual
Location Address: 2900 12TH AVE N STE 140W BILLINGS, MT 59101
Location Phone: (406) 237-5050
Location Fax: (406) 238-6599
Mailing Address: 2900 12TH AVE N STE 140W BILLINGS, MT 59101
Mailing Phone: (406) 237-5050
Mailing Fax: (406) 238-6599
Medical School Name: OTHER
Graduation Year: 2016
Is Sole Proprietor?: No
Enumeration Date: 08-11-2016
Last Update Date: 12-14-2021
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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: Physician Assistant Surgical
Taxonomy Code: 363AS0400X
Type: Physician Assistants & Advanced Practice Nursing Providers
License No.: MED-PAC-LIC-51936
License State: MT

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No.	Taxonomy Code	Type	Classification / Specialization	License No. (State)
1	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant

Insurance Plans Accepted

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

Blue Cross and Blue Shield of Montana

Blue Focus Bronze POS? 205 - POS
Blue Focus Bronze POS? 705 - POS
Blue Focus Bronze POS? Standard - POS
Blue Focus Gold POS? 207 - POS
Blue Focus Gold POS? 902 - POS
Blue Focus Gold POS? Standard - POS
Blue Focus Silver POS? 206 - POS
Blue Focus Silver POS? 903 - POS
Blue Focus Silver POS? Standard - POS
Blue Preferred Bronze PPO? 201 - PPO
Blue Preferred Bronze PPO? 202 - PPO
Blue Preferred Bronze PPO? Standard - PPO
Blue Preferred Gold PPO? 204 - PPO
Blue Preferred Gold PPO? 901 - PPO
Blue Preferred Gold PPO? Standard - PPO
Blue Preferred Security PPO? 200 - PPO
Blue Preferred Silver PPO? 203 - PPO
Blue Preferred Silver PPO? 308 - PPO
Blue Preferred Silver PPO? Standard - PPO

Mountain Health CO-OP

Peak PPO Bronze HDHP - PPO
Peak PPO Bronze Standard - PPO
Peak PPO Catastrophic - PPO
Peak PPO Gold - PPO
Peak PPO Gold Standard - PPO
Peak PPO Silver - PPO
Peak PPO Silver Standard - PPO
Plus Bronze - PPO
Plus Bronze Standard - PPO
Plus Gold - PPO
Plus Gold Standard - PPO
Plus Silver Standard - PPO
PEAK PPO BRONZE - PPO
PEAK PPO BRONZE HDHP - PPO
PEAK PPO GOLD - PPO
PEAK PPO GOLD HDHP - PPO
PEAK PPO SILVER - PPO
PEAK PPO SILVER HDHP - PPO
Plus Bronze HDHP - PPO
Plus Gold HDHP - PPO

PacificSource Health Plans

Core Bronze HSA 10600 - EPO
Core Bronze HSA 7500 - EPO
Core Bronze HSA 8300 - EPO
Core Gold 1500 - EPO
Core Gold 3000 - EPO
Core Silver 3500 - EPO
Core Silver 4500 - EPO
Core Silver 5000 - EPO
Core Silver 7500 - EPO
Core Standard Expanded Bronze HSA - EPO
Core Standard Gold - EPO
Core Standard Silver - EPO
PacificSource Oregon Standard Bronze HSA Plan Core - EPO
PacificSource Oregon Standard Gold Plan Core - EPO
PacificSource Oregon Standard Silver Plan Core - EPO

Providence Health Plan

HSA Qualified 7500 Bronze - Choice Network - EPO
HSA-E Qualified 7500 Bronze - Signature Network - EPO
Providence Oregon Standard Bronze Plan - Choice Network - EPO
Providence Oregon Standard Bronze Plan - Signature Network - EPO
Providence Oregon Standard Gold Plan - Choice Network - EPO
Providence Oregon Standard Gold Plan - Signature Network - EPO
Providence Oregon Standard Silver Plan - Choice Network - EPO
Providence Oregon Standard Silver Plan - Signature Network - EPO

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

Medicare Participation & PECOS Enrollment Status

Austin O'shea 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.

Austin O'shea 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: 3870877251
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: I20170302001696
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

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.

Follow-up hospital inpatient care per day, typically 25 minutes
Hernia repair (minimally invasive)
Hospital discharge day management, 30 minutes or less

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 94.3, 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: 94.3 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: 85.58

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: 100

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.

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
Documentation of Current Medications in the Medical Record	98%	1396
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
e-Prescribing	100%	707
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan	41%	961
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2
Promote Use of Patient-Reported Outcome Tools	Yes	N/A
Demonstrate performance of activities for employing patient-reported outcome (PRO) tools and corresponding collection of PRO data such as the use of PQH-2 or PHQ-9, PROMIS instruments, patient reported Wound-Quality of Life (QoL), patient reported Wound Outcome, and patient reported Nutritional Screening.
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	11%	1451
For at least one unique patient seen by the MIPS eligible clinician: (1) The patient (or the patient authorized representative) is provided timely access to view online, download, and transmit his or her health information; and (2) The MIPS eligible clinician ensures the patient's health information is available for the patient (or patient-authorized representative) to access using any application of their choice that is configured to meet the technical specifications of the Application Programing Interface (API) in the MIPS eligible clinician's certified EHR technology.
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.

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. Austin O'shea is affiliated with the following medical facilities:

Hospital Name	Address	Phone	Hospital Type	Overall Rating
BILLINGS CLINIC	2800 10TH AVE N BILLINGS, MT 59101	(406) 657-4000	Acute Care Hospitals

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 1346794930, we treat the final digit (0) 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 80. The final step is to find the difference between that total and the next multiple of ten (80 - 80 = 0).

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 → 14 → 1 + 4

Pos 6

Unchanged

Pos 7

Doubled → 8

Pos 8

Unchanged

Pos 9

Doubled → 6

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 7 → 14 → 5 4 → 8 3 → 6

Step 2: Add all digits plus the NPI constant

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

2 + 3 + 8 + 6 + 1 + 4 + 9 + 8 + 9 + 6 + 24 = 80

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

The next multiple of ten after 80 is 80. The difference is the calculated check digit.

80 - 80 = 0

This NPI is valid

The calculated check digit is 0, which matches the last digit of 1346794930.