DR. RAMON C PADILLA DDS
NPI 1356569024
Dentist - General Practice in Naples, FL

Medicare Participation & PECOS Enrollment Status

Ramon Padilla 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.

Ramon Padilla 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) and a Home Health Agency (HHA).

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: 2860757531

  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: I20180530000856

  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: No

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.

Complete reconstruction of lower or upper jaw bone with jaw bone implant (endosteal)

A complete reconstruction of the lower or upper jaw bone involves the use of an endosteal implant. This procedure involves placing a small, sturdy post made of titanium into the jawbone. Over time, the bone grows around the post, providing a secure base for a replacement tooth.

This service was performed 147 times for 57 patients

Creation of window into nasal sinus

The creation of a window into the nasal sinus is a procedure to improve sinus drainage. A small opening is made in the sinus wall to allow mucus and air to flow freely. This can help alleviate symptoms of sinusitis, like congestion or pressure.

This service was performed 20 times for 18 patients

Ct scan of face without contrast

A CT scan of the face without contrast is a non-invasive imaging procedure. It uses X-rays to create detailed pictures of your face, including bones, soft tissues, and blood vessels. It's often used to diagnose diseases, injuries, or abnormalities. No contrast dye is used in this procedure.

This service was performed 308 times for 222 patients

Established patient office or other outpatient visit, 30-39 minutes

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

This service was performed 541 times for 271 patients

Impression and custom preparation of oral surgical splint

An oral surgical splint is a device designed to protect your mouth, align your jaw, or aid in healing after surgery. The process involves taking an impression of your teeth to create a splint that fits perfectly. This custom-made device ensures comfort and effectiveness.

This service was performed 150 times for 125 patients

Impression and custom preparation of temporary oral prosthesis

This procedure involves taking an impression of your mouth to create a custom temporary oral prosthesis. This temporary device helps protect your teeth and gums while your permanent prosthesis is being made, ensuring a comfortable and effective fit.

This service was performed 197 times for 149 patients

Incision and repair of bony defect of cheek bone with repositioning of bony segment

This procedure involves making a cut to access and repair a defect in your cheek bone. The bone segment may be moved to a better position for healing. It's a common method to fix bone issues and promote proper healing.

This service was performed 341 times for 194 patients

New patient office or other outpatient visit, 45-59 minutes

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

This service was performed 88 times for 88 patients

Reconstruction of part of lower or upper jaw bone with implant

This procedure involves rebuilding a portion of your upper or lower jaw using an implant. The implant acts as a substitute for the missing bone, providing support and stability. This can improve your oral health, function, and appearance.

This service was performed 186 times for 116 patients

Removal of deep implant from bone

This procedure involves the careful extraction of an implant deeply embedded in a bone. A specialist makes a small incision, then utilizes precise instruments to reach and safely remove the implant. The area is then closed and monitored for healing.

This service was performed 29 times for 25 patients

Removal of dental bone growth with simple repair

This procedure involves the removal of excess bone growth in your mouth, often caused by conditions like Torus Palatinus or Mandibular Tori. After safely removing the growth, a simple repair is done to ensure proper healing and comfort. It's a standard oral surgery done under anesthesia.

This service was performed 75 times for 69 patients

Removal of face bone

Removal of a facial bone is a surgical procedure aimed at treating conditions like tumors or fractures. It involves making incisions to access the affected bone, then carefully removing it. This procedure requires general anesthesia and may result in temporary facial swelling or numbness.

This service was performed 115 times for 90 patients

Removal of growth or cyst of jaw or upper cheek

This procedure involves the surgical removal of a growth or cyst located in the jaw or upper cheek. It's done under anesthesia, so you won't feel pain during the process. The goal is to eliminate the abnormal tissue, relieve symptoms, and prevent potential health complications.

This service was performed 100 times for 87 patients

Removal of growth or cyst of lower jaw bone

This procedure involves the surgical removal of a growth or cyst from the lower jaw bone. It's performed under anesthesia. The surgeon makes an incision in the mouth or skin to access and remove the growth. This helps prevent further complications and improves oral health.

This service was performed 87 times for 80 patients

Removal of lower jaw bone

The removal of the lower jaw bone, or mandibulectomy, is a surgical procedure performed to treat conditions like oral cancer or severe trauma. It involves removing part or all of the lower jaw to prevent disease spread or repair damage. Post-surgery, reconstructive measures may be taken for functionality and appearance.

This service was performed 97 times for 79 patients

Repair of abnormal drainage tract between nasal sinuses

This procedure addresses an irregular drainage pathway from your nasal sinuses. The doctor uses a small, flexible tube with a camera to view the area and correct the issue. This helps to prevent infections and improve breathing.

This service was performed 23 times for 20 patients

Repair of lower jaw bone with bone graft

This procedure involves the use of bone grafts to repair defects or damages in your lower jaw bone. A bone graft is a piece of bone taken from another part of your body or a special bone material. It helps stimulate new bone growth and provide structural stability.

This service was performed 193 times for 118 patients

Repair of nasal or cheek bone with bone graft

This procedure involves fixing damaged nasal or cheek bones using a bone graft. A bone graft is a piece of healthy bone taken from another area of your body, or a special bone-like material. It's used to help your damaged bone heal, restore its original shape, or improve its function.

This service was performed 258 times for 144 patients

X-ray of lower jaws, upper jaws and teeth

An X-ray of lower jaws, upper jaws, and teeth is a diagnostic procedure that uses radiation to create images of these areas. This helps in identifying issues like tooth decay, gum problems, or jawbone irregularities. It's a quick, painless process and crucial for maintaining oral health.

This service was performed 626 times for 299 patients

X-ray of teeth, less than full mouth

An X-ray of teeth, less than full mouth, is a diagnostic procedure where a small portion of your mouth is imaged. It helps identify issues like cavities, infections, or bone loss not visible during a regular dental exam. It's a quick, painless process ensuring your oral health.

This service was performed 23 times for 20 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $22.92 for a new patient copayment and $18.25 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 34103 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 provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 75, 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: 75 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: N/A

  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: N/A

  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: N/A

  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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