CHERYL VIRGINIA TONEY APRN
NPI 1366400095
Nurse Practitioner in Whitesburg, GA

NPI Status: Active since May 03, 2006

Contact Information

41 WELLINGTON MILL RD
WHITESBURG, GA
ZIP 30185
Phone: (770) 836-0504
Fax: (770) 834-8261

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Medicare Participation & PECOS Status
Durable Medical Equipment
Physician Visit Costs
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Female
Nurse Practitioner
Accepts Insurance
PECOS Enrolled

About CHERYL TONEY

This page provides the complete NPI Profile along with additional information for Cheryl Toney, a provider established in Whitesburg, Georgia with a medical specialization in Nurse Practitioner. The healthcare provider is registered in the NPI registry with number 1366400095 assigned on May 2006. The practitioner's primary taxonomy code is 363L00000X with license number RN047891NP (GA). The provider is registered as an individual and her NPI record was last updated 19 years ago.

NPI: 1366400095
Provider Name: CHERYL VIRGINIA TONEY APRN
Gender: Female
Entity Type: Individual
Location Address: 41 WELLINGTON MILL RD WHITESBURG, GA 30185
Location Phone: (770) 836-0504
Location Fax: (770) 834-8261
Mailing Address: 41 WELLINGTON MILL RD WHITESBURG, GA 30185
Mailing Phone: (770) 836-0504
Mailing Fax: (770) 834-8261
Is Sole Proprietor?: Yes
Enumeration Date: 05-03-2006
Last Update Date: 07-08-2007
Code Navigator

A nurse practitioner (NP) like Cheryl Toney is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.

Location Map

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: Nurse Practitioner
Taxonomy Code: 363L00000X
Type: Physician Assistants & Advanced Practice Nursing Providers
License No.: RN047891NP
License State: GA
Taxonomy Description: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Insurance Plans Accepted

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

Alliant Health Plans, Inc.

SoloCare Bronze EPO $8500 DED HSA 10004 - EPO
SoloCare Exp Bronze EPO $9500 DED 10015 - EPO
SoloCare Gold EPO $1500 DED 10010 - EPO
SoloCare Silver EPO $5000 DED 10014 - EPO
SoloCare Silver EPO $6500 DED 10013 - EPO
SoloCare Standard Exp Bronze EPO $7500 DED 10008 - EPO
SoloCare Standard Gold EPO $2000 DED 10006 - EPO
SoloCare Standard Platinum EPO $0 DED 10005 - EPO
SoloCare Standard Silver EPO $6000 DED 10007 - EPO

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

Medicare Participation & PECOS Enrollment Status

Cheryl Toney 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
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

DME-Other DME (DE017N)
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (HCPCS:A4253)
7 DME suppliers used 27 Medicare Claims 56 Services Paid
DME-Medical/Surgical Supplies (DA000N)
Lancets, per box of 100 (HCPCS:A4259)
5 DME suppliers used 13 Medicare Claims 17 Services Paid
DME-Oxygen and Supplies (DC000N)
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing (HCPCS:E0431)
2 DME suppliers used 23 Medicare Claims 23 Services Paid
DME-Oxygen and Supplies (DC002N)
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)
1 DME suppliers used 19 Medicare Claims 19 Services Paid
DME-Other DME (DE017N)
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service (HCPCS:K0553)
4 DME suppliers used 24 Medicare Claims 24 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 30185 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

Average New Patient Price $83.23
Minimum New Patient Price $53.31
Maximum New Patient Price $164.04

Average New Patient Copayment $20.8
Minimum New Patient Copayment $13.32
Maximum New Patient Copayment $41.01

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

Average Established Patient Price $94.84
Minimum Established Patient Price $16.68
Maximum Established Patient Price $133.24

Average Established Patient Copayment $23.71
Minimum Established Patient Copayment $4.17
Maximum Established Patient Copayment $33.31

* 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.

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 1366400095, we treat the final digit (5) 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 55. The final step is to find the difference between that total and the next multiple of ten (60 - 55 = 5).

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 → 12 → 1 + 2

Pos 4

Unchanged

Pos 5

Doubled → 8

Pos 6

Unchanged

Pos 7

Doubled → 0

Pos 8

Unchanged

Pos 9

Doubled → 18 → 1 + 8

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 6 → 12 → 3 4 → 8 0 → 0 9 → 18 → 9

Step 2: Add all digits plus the NPI constant

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

2 + 3 + 1 + 2 + 6 + 8 + 0 + 0 + 0 + 1 + 8 + 24 = 55

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

The next multiple of ten after 55 is 60. The difference is the calculated check digit.

60 - 55 = 5

This NPI is valid

The calculated check digit is 5, which matches the last digit of 1366400095.