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THOMAS E MARSHALL MD
NPI 1376571687
Ophthalmology in Baytown, TX

Active since June 28, 2006PECOS EnrolledAccepts Medicare Assignment
83.66/100
CMS Quality Rating
1025 BIRDSONG DR STE A, BAYTOWN, TX 77521(281) 422-2020(281) 422-4959 Get Directions Write a Review

NPPES record last updated: October 16, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 20, 2023, Jun 20, 2023 (2 updates tracked since 2023).

About Thomas E Marshall Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

THOMAS E MARSHALL MD (NPI 1376571687) is an individual ophthalmology provider in Baytown, Texas, licensed in Texas (H0603) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS, is affiliated with Houston Methodist Baytown Hospital, and is a graduate of University Of Texas Medical School At San Antonio (1985).

NPPES Registry Identity

NPI1376571687
Entity TypeIndividualMale
Primary Taxonomy207W00000X
Provider Legal NameTHOMAS E MARSHALLCredential: MD
Location Address1025 BIRDSONG DR STE ABaytown, TX 77521-3771
Mailing Address21502 Merchants WayKaty, TX 77449-2517 · (281) 944-2232 · Fax (281) 944-2290
Phone(281) 422-2020
Fax(281) 422-4959
Sole ProprietorNo
Medical School CMSUniversity Of Texas Medical School At San AntonioGraduated 1985
Enumeration DateJune 28, 2006
Last NPPES UpdateOctober 16, 20242 updates tracked since enumeration
NPPES CertifiedOctober 16, 2024
✔ NPI 1376571687 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOphthalmologyAllopathic & Osteopathic Physicians
Taxonomy Code207W00000X
License✔ Licensed in TX · H0603
Definition
An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.
1025 BIRDSONG DR STE A, Baytown, TX 77521
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Other Identifiers 1

Medicaid125529103TX

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Thomas E Marshall Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9234211095
PECOS Enrollment IDI20101027001358
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 11

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient complete exam of visual system 92014
An established patient complete exam of the visual system involves a thorough check of your eyes and vision. It assesses eye health, checks for diseases, and measures your ability to see clearly at different distances. It's a routine, non-invasive procedure.
333 services288 patients
Measurement of corneal curvature and depth of eye 92136
This procedure measures the shape and depth of your eye, specifically the cornea, the clear front surface. It helps in diagnosing conditions, planning for surgeries, or fitting contact lenses. It's non-invasive and painless.
271 services109 patients
Removal of cataract with insertion of prosthetic lens 66984
This is a procedure where a cloudy lens in your eye, known as a cataract, is removed. After removal, a clear artificial lens is inserted. This helps to restore your vision, enabling you to see clearly again.
139 services89 patients
Imaging of retina 92134
Imaging of the retina is a non-invasive procedure that captures detailed images of your eye's interior. This helps detect conditions like macular degeneration or retinal detachment. It's painless and takes only a few minutes.
88 services76 patients
Established patient problem focused exam of visual system 92012
This is a routine check-up for existing patients focusing on the visual system. It involves examining your eyes to detect any potential issues or changes in your vision. It's a crucial part of maintaining good eye health.
84 services67 patients
Imaging of optic nerve 92133
Imaging of the optic nerve is a non-invasive procedure that captures detailed pictures of your optic nerve. It helps doctors assess eye health, particularly for conditions like glaucoma. It's painless, quick, and uses safe technology like MRI or OCT (Optical Coherence Tomography).
73 services70 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Houston Methodist Baytown Hospital

Acute Care Hospitals · Baytown, TX
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number450424
Location4401 Garth RoadBaytown, TX 77521 · Harris County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 77521 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$134.06 typical visit price
range $58.24 – $176.98
Typical copayment $33.51 (range $14.56 – $44.24)
Most-billed visit code 99204
Established Patient
$72.62 typical visit price
range $18.60 – $143.93
Typical copayment $18.15 (range $4.65 – $35.98)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

83.66/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality90.45
Improvement Activities40
Cost63.05

Reported Quality Measures

Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement
Percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) or their caregiver(s) who were counseled within 12 months on the benefits and/or risks of the Age-Related Eye Disease Study (AREDS) formulation for…
29%218 patients2/55-star benchmark: 100%
Age-Related Macular Degeneration (AMD): Dilated Macular Examination
Percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or geographic atrophy or…
98%218 patients4/55-star benchmark: 100%
Closing the Referral Loop: Receipt of Specialist Report
Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred
46%28 patients2/55-star benchmark: 95%
Diabetes: Eye Exam
Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period
100%91 patients5/55-star benchmark: 100%
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus…
73%142 patients3/55-star benchmark: 100%
Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during…
93%150 patients4/55-star benchmark: 100%
Documentation of Current Medications in the Medical Record
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.
88%2,987 patients3/55-star benchmark: 100%
Falls: Screening for Future Fall Risk
Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period
0%1,623 patients1/55-star benchmark: 99%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Patients screenedForUse: 99% · 701 patients
Patients tobacco: 96% · 701 patients
4%24 patients1/55-star benchmark: 98%
Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation
Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits within 12 months
94%395 patients4/55-star benchmark: 100%
Use of High-Risk Medications in the Elderly
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication.
Lower rates are better for this measure.
Patients 2+: 0% · 1,623 patients
0%1,623 patients5/55-star benchmark: 100%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. HANH MAI NGUYEN O.D.
Optometrist
1025 BIRDSONG DR STE A
BAYTOWN, TX 77521
Harris County (281) 422-2020
MARTIN J ARISCO MD
Ophthalmology
1025 BIRDSONG DR STE A
BAYTOWN, TX 77521
Harris County (281) 422-2020
BERKELEY EYE INSTITUTE, PLLC
Ophthalmology
1025 BIRDSONG DR STE A
BAYTOWN, TX 77521
Harris County (281) 422-2020

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Thomas Marshall's NPI number?

The NPI number for Thomas Marshall is 1376571687. It was assigned to this individual provider in the NPPES registry on June 28, 2006.

Where is Thomas Marshall located?

Thomas Marshall practices at 1025 Birdsong Dr Ste A, Baytown, TX 77521. The listed phone number is (281) 422-2020.

What is Thomas Marshall's specialty?

The primary specialty registered for this NPI is Ophthalmology with taxonomy code 207W00000X.

Is Thomas Marshall enrolled in Medicare?

Yes. Thomas Marshall is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Thomas Marshall accept?

Health plans from Ambetter Health, Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and Ambetter from Superior HealthPlan and 11 other insurers list Thomas Marshall as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Thomas Marshall affiliated with any hospitals?

According to CMS data, Thomas Marshall is affiliated with Houston Methodist Baytown Hospital.

When was this NPI record last updated?

The NPPES record for Thomas Marshall was last updated on October 16, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.