DARLA RENEE HESS
NPI 1396473898
Nurse Practitioner - Psychiatric/Mental Health in Tyler, TX

NPI Status: Active since August 11, 2022

Contact Information

4519 TROUP HWY
TYLER, TX
ZIP 75703
Phone: (903) 597-7558

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  • Individual
  • Female
  • Years of Experience 3
  • Nurse Practitioner
  • Psychiatric/Mental Health
  • PECOS Enrolled
  • Accepts Medicare Approved Payment

About DARLA HESS

Darla Hess is a provider established in Tyler, Texas and her medical specialization is Nurse Practitioner with a focus in psychiatric/mental health with more than 3 years of experience. The healthcare provider is registered in the NPI registry with number 1396473898 assigned on August 2022. The practitioner's primary taxonomy code is 363LP0808X with license number 1088490 (TX). The provider is registered as an individual and her NPI record was last updated 2 years ago.

NPI
1396473898
Provider Name
DARLA RENEE HESS
Gender
Female
Entity Type
Individual
Location Address
4519 TROUP HWY TYLER, TX 75703
Location Phone
(903) 597-7558
Mailing Address
4519 TROUP HWY TYLER, TX 75703
Mailing Phone
(903) 597-7558
Medical School Name
OTHER
Graduation Year
2021
Is Sole Proprietor?
Yes
Enumeration Date
08-11-2022
Last Update Date
08-11-2022
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A nurse practitioner (NP) like Darla Hess 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.

Darla Hess 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.

The typical physician office visit costs for Medicare beneficiaries in this area are: $21.84 for a new patient copayment and $25.3 for an established patient copayment.

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 Psychiatric/Mental Health

Taxonomy Code
363LP0808X
Type
Physician Assistants & Advanced Practice Nursing Providers
License No.
1088490
License State
TX

Insurance Plans Accepted

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

  • Ambetter from Arizona Complete Health

    • Choice Bronze HSA - HMO
    • Choice Bronze HSA + Vision + Adult Dental - HMO
    • Clear Gold - HMO
    • Clear Gold + Vision + Adult Dental - HMO
    • Clear Silver - HMO
    • Clear Silver + Vision + Adult Dental - HMO
    • Complete Gold - HMO
    • Complete Gold + Vision + Adult Dental - HMO
    • Complete Silver - HMO
    • Complete Silver + Vision + Adult Dental - HMO
  • Ambetter from Arkansas Health & Wellness

    • Choice Bronze HSA (QualChoice) - POS
    • Complete Gold - PPO
    • Complete Gold + Vision + Adult Dental - PPO
    • Complete Silver - PPO
    • Complete Silver + Vision + Adult Dental - PPO
    • Connected Silver - PPO
    • Connected Silver (QualChoice) - POS
    • Connected Silver (QualChoiceLife) - PPO
    • Connected Silver + Vision + Adult Dental - PPO
    • Elite Bronze - PPO
  • Ambetter from Louisiana Healthcare Connections

    • Clear Silver - EPO
    • Clear Silver + Vision + Adult Dental - EPO
    • 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
    • Everyday Bronze - EPO
    • Everyday Bronze + Vision + Adult Dental - EPO
  • Ambetter from Superior HealthPlan

    • Ambetter Virtual Access Gold (Virtual PCP selection required) - HMO
    • Ambetter Virtual Access Silver (Virtual PCP selection required) - HMO
    • Clear Gold - EPO
    • Clear Gold + Vision + Adult Dental - EPO
    • Clear Silver - EPO
    • Clear Silver + Vision + Adult Dental - EPO
    • Complete Gold - EPO
    • Complete Gold + Vision + Adult Dental - EPO
    • Complete Silver - EPO
    • Complete Silver + Vision + Adult Dental - EPO
  • Ambetter of Oklahoma

    • Clear Gold - PPO
    • Clear Gold + Vision + Adult Dental - PPO
    • Clear Silver - PPO
    • Clear Silver + Vision + Adult Dental - PPO
    • Complete Silver - PPO
    • Complete Silver + Vision + Adult Dental - PPO
    • Elite Bronze - PPO
    • Elite Bronze + Vision + Adult Dental - PPO
    • Elite Gold - PPO
    • Elite Gold + Vision + Adult Dental - PPO
  • UnitedHealthcare

    • UHC Bronze Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx, $0 Insulin) (Disponible en espanol) - HMO
    • UHC Gold Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx, $0 Insulin) (Disponible en espanol) - HMO
    • UHC Silver Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx, $0 Insulin) (Disponible en espanol) - HMO

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

PECOS Enrollment and Medicare Participation Status

Darla Hess 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: 8921461260

    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: I20230901003456

    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

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 75703 ZIP code area.

New Patients Visit Costs *

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

  • Average New Patient Price $87.36
  • Minimum New Patient Price $56.75
  • Maximum New Patient Price $172.6
  • Average New Patient Copayment $21.84
  • Minimum New Patient Copayment $14.18
  • Maximum New Patient Copayment $43.15

Established Patients Visit Costs *

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

  • Average Established Patient Price $101.2
  • Minimum Established Patient Price $17.72
  • Maximum Established Patient Price $141.29
  • Average Established Patient Copayment $25.3
  • Minimum Established Patient Copayment $4.43
  • Maximum Established Patient Copayment $35.32

* 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.

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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.
1396473898
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
23186876818
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 3 + 1 + 8 + 6 + 8 + 7 + 6 + 8 + 1 + 8 + 24 = 82
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
90 - 82 = 88

The NPI number 1396473898 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 3 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1922640481 LAUREN GANDY LPC
Individual
Counselor (Professional)4519 TROUP HWY
TYLER, TX 75703
(903) 289-9252
1295208817 GABRIELA NEW FNP
Individual
Nurse Practitioner (Family)4519 TROUP HWY
TYLER, TX 75703
(903) 289-9252
1184103285SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED
Organization
Clinic/Center (Federally Qualified Health Center (FQHC))4519 TROUP HWY
TYLER, TX 75703
(903) 289-9252

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1396473898, enumerated in the NPI registry as an "individual" on August 11, 2022

The provider is located at 4519 Troup Hwy Tyler, Tx 75703 and the phone number is (903) 597-7558

The provider's speciality is Nurse Practitioner with taxonomy code 363LP0808X with a focus in Psychiatric/Mental Health

The provider has more than 3 years of experience.

The provider might be accepting Accepts: Ambetter from Arizona Complete Health, Ambetter. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Yes, as of May 17, 2024 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a 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.

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 $101.2 and an average copayment of 25.3. Please review your insurance plan or contact the provider directly to determine your specific costs.

This NPI record was last updated on August 11, 2022. 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].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.