KARL ANTHONY SIMON P.A. NPI 1356671630
Physician Assistant in Dalhart, TX
About KARL ANTHONY SIMON P.A.
Karl Simon is a primary care provider established in Dalhart, Texas and his medical specialization is Physician Assistant with more than 14 years of experience. The NPI number of this provider 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 2 years ago.
| NPI | 1356671630 |
| Provider Name | KARL ANTHONY SIMON P.A. |
| Location Address | 1411 DENVER AVE DALHART, TX 79022 |
| Location Phone | (806) 244-9267 |
| Mailing Address | 7415 BROKEN OAK LANE SUGAR LAND, TX 77479 |
| Gender | Male |
| NPI Entity Type | Individual |
| Medical School Name | OTHER |
| Graduation Year | 2009 |
| Is Sole Proprietor? | Yes |
| Enumeration Date | 01-08-2010 |
| Last Update Date | 07-30-2021 |
A primary care provider (PCP) like Karl Simon 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 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.
Karl Simon is registered with Medicare and accepts claims assignment, this means the provider accepts Medicare's approved amount for the cost of rendered services as full payment. Participating providers may not charge Medicare beneficiaries more than Medicare's approved amount for their services. Medicare beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.
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.
The typical physician office visit costs for Medicare beneficiaries in this area are: $21.84 for a new patient copayment and $17.81 for an established patient copayment.
Primary Taxonomy
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.
| 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
1411 DENVER AVE
DALHART, TX
ZIP 79022
Phone: (806) 244-9267
Mailing Address
7415 BROKEN OAK LANE
SUGAR LAND, TX
ZIP 77479
Phone: (832) 265-7883
Location Map
PECOS Enrollment and Medicare Participation Status
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 |
| PECOS PAC ID | 9335263664 |
| PECOS Enrollment ID | I20100824000391 |
| 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 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 |
Physician Office Visit Costs
The provider accepts as payment the Medicare approved amount. Medicare beneficiaries should not be billed for more than the Medicare deductible and coinsurance amounts. Medicare pricing is usually a reference point for private insurance covered patients. The prices below reflect the costs for new and established patients in the 79022 ZIP code area.
| New Patients Office Visits Costs * | ||
|---|---|---|
| Most Utilized Procedure Code for new patients office visits: 99203 | ||
| Minimum New Patient Pricing | Maximum New Patient Pricing | Typical New Patient Pricing |
| $56.75 | $172.6 | $87.36 |
| Minimum New Patient Copayment | Maximum New Patient Copayment | Typical New Patient Copayment |
| $14.18 | $43.15 | $21.84 |
| Established Patients Office Visits Costs * | ||
|---|---|---|
| Most Utilized Procedure Code for established patients office visits: 99213 | ||
| Minimum Established Patient Pricing | Maximum Established Patient Pricing | Typical Established Patient Pricing |
| $17.72 | $141.29 | $71.24 |
| Minimum Established Patient Copayment | Maximum Established Patient Copayment | Typical Established Patient Copayment |
| $4.43 | $35.32 | $17.81 |
* The physician office visit costs information is obtained by Medicare's 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 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. | |||||||
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. | |||||||||
| 1 | 3 | 5 | 6 | 6 | 7 | 1 | 6 | 3 | 0 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 3 | 10 | 6 | 12 | 7 | 2 | 6 | 6 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 3 + 1 + 0 + 6 + 1 + 2 + 7 + 2 + 6 + 6 + 24 = 60 | |||||||||
| Step 3: because the number obtained in step 2 ends in zero, the check digit is zero. | |||||||||
| 0 | |||||||||
The NPI number 1356671630 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.
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 |
| 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 |
| 1871133561 | LEAH BREEANN FORD APRN Individual | Nurse Practitioner | 1411 DENVER AVE DALHART, TX 79022 (512) 869-9298 |
Frequently Asked Questions
What is Karl Simon P.A. NPI number?
The NPI number assigned to this healthcare provider is 1356671630, registered as an "individual" on January 08, 2010
Where is Karl Simon P.A. located?
The provider is located at 1411 Denver Ave Dalhart, Tx 79022 and the phone number is (806) 244-9267
Which is Karl Simon P.A. specialty?
The provider's speciality is Physician Assistant
How many years of experience does Karl Simon P.A. have?
The provider has more than 14 years of experience.
Is Karl Simon P.A. registered in PECOS?
Yes, as of March 13, 2023 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a Medicare 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.
What are Karl Simon P.A. Quality Ratings?
The provider has an overall high rating in the following quality measures: quality clinical practices and patient outcomes and experiences.
How much is a visit to Karl Simon P.A.?
Medicare beneficiaries should expect a typical cost of $87.36 with an average copayment of $21.84 for new patient appointments. Established patients should expect a typical charge of $71.24 and an average copayment of 17.81. Please review your insurance plan or contact the provider directly to determine your specific costs.
How do I update my NPI information?
The NPI record of Karl Simon P.A. was last updated on January 08, 2010. 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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