KARL ANTHONY SIMON P.A. NPI 1356671630
Physician Assistant in Dalhart, TX
About KARL SIMON
Karl Simon is a primary care provider established in Dalhart, Texas and his medical specialization is physician assistant. The NPI number of Karl Simon is 1356671630 and was assigned on January 2010. The practitioner's primary taxonomy code is 363A00000X with license number PA06580 (TX). The provider is registered as an individual and his NPI record was last updated one year ago.
A primary care provider (PCP) like Karl Anthony Simon P.a. 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
Karl Simon is enrolled in PECOS and is eligible to order or refer healthcare 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.
Karl Simon is a non-participating provider of Medicare. If you are a Medicare beneficiary this means the provider can charge up to 15% more than Medicare's approved amount for the cost of rendered services, in addition to your normal deductible and coinsurance costs. There are some states that restrict the limiting charge when you see non-participating provider. If you pay the full cost of your care up front, your non- participating provider should still submit a claim to Medicare. Afterward, you should receive reimbursement from Medicare for up 80% of the Medicare-approved amount for the services rendered.
The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 94.8, 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.
| NPI | 1356671630 |
| Provider Name | KARL ANTHONY SIMON P.A. |
| Provider Location Address | 1411 DENVER AVE DALHART, TX 79022 |
| Provider Mailing Address | 7415 BROKEN OAK LANE SUGAR LAND, TX 77479 |
| Gender | Male |
| NPI Entity Type | Individual |
| Is Sole Proprietor? | Yes |
| Is Organization Subpart? | N/A |
| Enumeration Date | 01-08-2010 |
| Last Update Date | 07-30-2021 |
Primary Taxonomy
| Taxonomy Code | 363A00000X |
| Classification | Physician Assistant |
| Type | Physician Assistants & Advanced Practice Nursing Providers |
| License No. | PA06580 |
| License State | TX |
| Taxonomy Description | A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
Business Address
KARL ANTHONY SIMON P.A.
1411 DENVER AVE
DALHART, TX
ZIP 79022
Phone: (806) 244-9267
Mailing Address
KARL ANTHONY SIMON P.A.
7415 BROKEN OAK LANE
SUGAR LAND, TX
ZIP 77479
Phone: (832) 265-7883
Medicare Participation
What is PECOS?
PECOS is the Medicare Provider, Enrollment, Chain and Ownership System. PECOS is Medicare's enrollment and revalidation system and it is the primary source of information about verified Medicare professionals. A NPI number is necessary to register in PECOS. Providers must enroll in PECOS to avoid denied claims.
| Registered in PECOS? | Yes |
| Eligible order / refer Part B Clinical Laboratory and Imaging | Yes |
| Eligible order / refer Durable Medical Equipment | Yes |
| Eligible order / refer Home Health Agency (HHA) | Yes |
| Eligible order / refer Power Mobility Devices | Yes |
Overall MIPS Quality Performance
The Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in Medicare's 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.
| MIPS Measure | Score Weight | Score | |
|---|---|---|---|
| Quality | 40% | 100 | |
|
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. |
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| Promoting Interoperability (PI) | 25% | 71.2 | |
|
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. |
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| Improvement Activities | 15% | 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 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. |
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| Cost | 20% | 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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| MIPS Final Score | - | 94.8 | |
| 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. | |||
Secondary Taxonomies
The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.
| No. | Taxonomy Code | Type | Classification | Specialization | License No. | State | Primary |
|---|---|---|---|---|---|---|---|
| 1 | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 1088804 | TX | No | |
Taxonomy Description: a physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. | |||||||
Other Providers at the same location
The following 18 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1457474660 | MRS. KATHY M KELSO M.S. CCC-SLP Individual | Speech-Language Pathologist | 1411 DENVER AVE DALHART, TX 79022 (806) 244-4571 |
| 1265766133 | TANYA SMITH P.T.A Individual | Physical Therapy Assistant | 1411 DENVER AVE DALHART, TX 79022 (806) 244-4571 |
| 1942610514 | KATY ANN SAWYER PTA Individual | Physical Therapy Assistant | 1411 DENVER AVE DALHART, TX 79022 (806) 244-0015 |
| 1629478466 | DALLAM-HARTLEY COUNTIES HOSPITAL DISTRICT Organization | Pharmacy (Institutional Pharmacy) | 1411 DENVER AVE DALHART, TX 79022 (806) 244-4571 |
| 1629248943 | DALLAM-HARTLEY COUNTIES HOSPITAL DISTRICT Organization | Durable Medical Equipment & Medical Supplies | 1411 DENVER AVE DALHART, TX 79022 (806) 244-4571 |
| 1164900999 | BIANCA CRYSTAL RETANA COTA Individual | Occupational Therapy Assistant | 1411 DENVER AVE DALHART, TX 79022 (806) 244-0016 |
| 1104323336 | JASON BEN WU NP-C Individual | Nurse Practitioner (Family) | 1411 DENVER AVE DALHART, TX 79022 (806) 244-4571 |
| 1609341338 | BARBARA ELAINE LEDBETTER Individual | Registered Nurse (Registered Nurse First Assistant) | 1411 DENVER AVE DALHART, TX 79022 (806) 244-9241 |
| 1124596499 | HCC OF DALHART LLC Organization | Internal Medicine | 1411 DENVER AVE DALHART, TX 79022 (806) 244-4571 |
| 1154899425 | ESS OF DALHART LLC Organization | Emergency Medicine | 1411 DENVER AVE DALHART, TX 79022 (806) 244-4571 |
| 1710445390 | JONATHAN PAUL SOMMER Individual | Physical Medicine & Rehabilitation | 1411 DENVER AVE DALHART, TX 79022 (346) 305-9738 |
| 1871133561 | LEAH BREEANN FORD APRN Individual | Emergency Medicine (Emergency Medical Services) | 1411 DENVER AVE DALHART, TX 79022 (512) 869-9298 |
| 1649887308 | AMBER DON DURAN LMSW Individual | Social Worker | 1411 DENVER AVE DALHART, TX 79022 (806) 244-4571 |
| 1184631947 | JASON MAYFIELD WRIGHT MPAS, PA-C Individual | Physician Assistant (Medical) | 1411 DENVER AVE DALHART, TX 79022 (806) 244-9251 |
| 1871956037 | EUGENE TRAVIS STONE III MD Individual | Emergency Medicine | 1411 DENVER AVE DALHART, TX 79022 (832) 498-2040 |
| 1245353747 | DALLAM-HARTLEY COUNTIES HOSPITAL DISTRICT Organization | General Acute Care Hospital (Critical Access) | 1411 DENVER AVE DALHART, TX 79022 (806) 244-4571 |
| 1336262831 | DALLAM-HARTLEY COUNTIES HOSPITAL DISTRICT Organization | General Acute Care Hospital (Critical Access) | 1411 DENVER AVE DALHART, TX 79022 (806) 244-4571 |
| 1639176456 | DALLAM-HARTLEY COUNTIES HOSPITAL DISTRICT Organization | General Acute Care Hospital (Critical Access) | 1411 DENVER AVE DALHART, TX 79022 (806) 244-4571 |
NPI Footnotes
What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.
Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date
The date that a NPI record was last updated or changed.
Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.