DR. PETER DAVID CANDELORA MD
NPI 1376547729
Orthopaedic Surgery in New Port Richey, FL

NPI Status: Active since June 13, 2005

Contact Information

5145 DEER PARK DR
NEW PORT RICHEY, FL
ZIP 34653
Phone: (727) 848-1417
Fax: (727) 847-7526

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

Individual
Male
Years of Experience 42
Orthopaedic Surgery
Accepts Insurance
Accepts Medicare Approved Payment
PECOS Enrolled
Medicare Quality Reporting

About PETER CANDELORA

This page provides the complete NPI Profile along with additional information for Peter Candelora, a provider established in New Port Richey, Florida with a medical specialization in Orthopaedic Surgery and more than 42 years of experience. He graduated from Tulane University School Of Medicine in 1984. The healthcare provider is registered in the NPI registry with number 1376547729 assigned on June 2005. The practitioner's primary taxonomy code is 207X00000X with license number ME0079772 (FL). The provider is registered as an individual and his NPI record was last updated 15 years ago.

NPI: 1376547729
Provider Name: DR. PETER DAVID CANDELORA MD
Gender: Male
Entity Type: Individual
Location Address: 5145 DEER PARK DR NEW PORT RICHEY, FL 34653
Location Phone: (727) 848-1417
Location Fax: (727) 847-7526
Mailing Address: 5145 DEER PARK DR NEW PORT RICHEY, FL 34653
Mailing Phone: (727) 848-1417
Mailing Fax: (727) 847-7526
Medical School Name: TULANE UNIVERSITY SCHOOL OF MEDICINE
Graduation Year: 1984
Is Sole Proprietor?: Yes
Enumeration Date: 06-13-2005
Last Update Date: 05-04-2011
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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: Orthopaedic Surgery
Taxonomy Code: 207X00000X
Type: Allopathic & Osteopathic Physicians
License No.: ME0079772
License State: FL
Taxonomy Description: An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.

Insurance Plans Accepted

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

Ambetter from Superior HealthPlan

Complete VALUE Gold - HMO
Focused VALUE Silver - HMO
Focused VALUE Silver + Vision + Adult Dental - HMO
Standard Gold VALUE - HMO
Standard Silver VALUE - HMO
Standard Silver VALUE + Vision + Adult Dental - HMO

Ambetter Health

Clarity Silver - HMO
Clarity VALUE Silver - HMO
Complete Gold - HMO
Complete Gold + Vision + Adult Dental - HMO
Complete VALUE Gold - HMO
Elite Bronze - HMO
Elite Bronze + Vision + Adult Dental - HMO
Elite VALUE Bronze - HMO
Enhanced Diabetes Care Silver with $0 Drug Options - HMO
Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - HMO

Ambetter of Alabama

Complete Gold - EPO
Complete Gold + Vision + Adult Dental - EPO
Elite Bronze - EPO
Elite Bronze + Vision + Adult Dental - EPO
Elite Gold - EPO
Elite Gold + Vision + Adult Dental - EPO
Enhanced Diabetes Care Silver with $0 Drug Options - EPO
Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
Everyday Bronze - EPO
Everyday Bronze + Vision + Adult Dental - EPO

Florida Blue (BlueCross BlueShield FL)

BlueOptions Bronze (HSA) 24J01-10 (Rewards / $4 Condition Care Rx) - PPO
BlueOptions Bronze 24J01-04 (3 PCP Visits for $0 then $55 / $70 Specialist Visits / Rewards) - PPO
BlueOptions Bronze 24J01-06 (Rewards) - PPO
BlueOptions Bronze 24J01-17 ($50 PCP Visits / Rewards) - PPO
BlueOptions Bronze 24J01-18S ($50 PCP Visits / Rewards) - PPO
BlueOptions Gold 24J01-09 ($0 Deductible / $15 PCP Visits / $75 Specialist Visits / $20 Labs / Rewards) - PPO
BlueOptions Gold 24J01-12 ($40 PCP Visits / $75 Specialist Visits / $15 Labs / Rewards) - PPO
BlueOptions Gold 24J01-20S ($30 PCP Visits / $60 Specialist Visits / Rewards) - PPO
BlueOptions Platinum 24J01-05 ($0 Labs / $15 PCP Visits / $35 Specialist Visits / Rewards) - PPO
BlueOptions Platinum 24J01-08 ($0 Deductible / $0 Labs / $15 PCP Visits / $25 Specialist Visits / Rewards) - PPO

Florida Blue HMO (a BlueCross BlueShield FL company)

BlueCare Bronze (HSA) 24K01-09 (Rewards / $4 Condition Care Rx) - POS
BlueCare Bronze 24K01-03 (3 PCP Visits for $0 then $55 / $70 Specialist Visits / Rewards) - POS
BlueCare Bronze 24K01-05 (Rewards) - POS
BlueCare Bronze 24K01-25 ($50 PCP Visits / $75 Specialist Visits / Rewards) - POS
BlueCare Bronze 24K01-31S ($50 PCP Visits / Rewards) - POS
BlueCare Bronze 24K02-17 (3 PCP Visits for $0 then $55 / $70 Specialist Visits / Rewards) - POS
BlueCare Bronze 24K02-18 (Rewards) - POS
BlueCare Bronze 24K02-23 ($50 PCP Visits / $75 Specialist Visits / Rewards) - POS
BlueCare Bronze 24K02-26S ($50 PCP Visits / Rewards) - POS
BlueCare Gold 24K01-08 ($0 Deductible / $15 PCP Visits / $75 Specialist Visits / $20 Labs / Rewards) - POS

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

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

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State
B63812	MEDICARE UPIN (02)	FL
063480800	MEDICAID (05)	FL
08830Y	MEDICARE ID-TYPE UNSPECIFIED (04)	FL

Medicare Participation & PECOS Enrollment Status

Peter Candelora 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.

Peter Candelora 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: 1052333028
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: I20051220000057
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.

Aspiration and/or injection of fluid from large joint
Established patient office or other outpatient visit, 20-29 minutes
Established patient office or other outpatient visit, 30-39 minutes
Hip replacement
Hyaluronan or derivative, gel-one, for intra-articular injection, per dose
Initial hospital inpatient care per day, typically 50 minutes
Injection, methylprednisolone sodium succinate, up to 125 mg
Knee replacement
Lower limb (leg) arthroscopy (minimally invasive joint repair)
New patient office or other outpatient visit, 30-44 minutes
New patient office or other outpatient visit, 45-59 minutes
Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and
Replacement of knee joint, both sides of knee
Upper limb (arm) arthroscopy (minimally invasive joint repair)
X-ray of hip, 2-3 views
X-ray of knee, 1-2 views
X-ray of knee, 3 views
X-ray of shoulder, minimum of 2 views

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $21.9 for a new patient copayment and $17.51 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 34653 ZIP code area.

New Patients Visit Costs *

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

Average New Patient Price $87.62
Minimum New Patient Price $56
Maximum New Patient Price $171.84

Average New Patient Copayment $21.9
Minimum New Patient Copayment $14
Maximum New Patient Copayment $42.96

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

Average Established Patient Price $70.04
Minimum Established Patient Price $17.57
Maximum Established Patient Price $139.16

Average Established Patient Copayment $17.51
Minimum Established Patient Copayment $4.39
Maximum Established Patient Copayment $34.79

* 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.

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	100%	1330
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	73%	141
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Falls: Plan of Care	100%	106
Percentage of patients aged 65 years and older with a history of falls that had a plan of care for falls documented within 12 months
Falls: Risk Assessment	100%	106
Percentage of patients aged 65 years and older with a history of falls that had a risk assessment for falls completed within 12 months
Health Information Exchange	97%	30
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for at least one transition of care or referral.
Implementation of medication management practice improvements	Yes	N/A
Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/or Conduct periodic, structured medication reviews.
Medication Reconciliation	100%	53
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
Patient-Specific Education	8%	203
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan	91%	714
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
Preventive Care and Screening: Screening for Depression and Follow-Up Plan	89%	719
Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen
Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling	76%	261
Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 24 months AND who received brief counseling if identified as an unhealthy alcohol user
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	73%	203
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information.
Secure Messaging	36%	203
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period.
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. Peter Candelora is affiliated with the following medical facilities:

Hospital Name	Address	Phone	Hospital Type	Overall Rating
ADVENTHEALTH NORTH PINELLAS	1395 S PINELLAS AVE TARPON SPRINGS, FL 34689	(727) 942-5000	Acute Care Hospitals
HCA FLORIDA TRINITY HOSPITAL	9330 SR 54 TRINITY, FL 34655	(727) 834-4900	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 1376547729, we treat the final digit (9) 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 61. The final step is to find the difference between that total and the next multiple of ten (70 - 61 = 9).

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 → 14 → 1 + 4

Pos 4

Unchanged

Pos 5

Doubled → 10 → 1 + 0

Pos 6

Unchanged

Pos 7

Doubled → 14 → 1 + 4

Pos 8

Unchanged

Pos 9

Doubled → 4

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 7 → 14 → 5 5 → 10 → 1 7 → 14 → 5 2 → 4

Step 2: Add all digits plus the NPI constant

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

2 + 3 + 1 + 4 + 6 + 1 + 0 + 4 + 1 + 4 + 7 + 4 + 24 = 61

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

The next multiple of ten after 61 is 70. The difference is the calculated check digit.

70 - 61 = 9

This NPI is valid

The calculated check digit is 9, which matches the last digit of 1376547729.