DR. OSCAR TANYAG ORTIZ M.D.
NPI 1396719662
Specialist in Toms River, NJ
Quality Rating: 75 out of 100 score
NPI Status: Active since February 14, 2006
Contact Information
1163 ROUTE 37 WEST
SUITE A-1
TOMS RIVER, NJ
ZIP 08755
Phone: (732) 736-1000
Fax: (732) 736-8811
- Individual
- Male
- Years of Experience 44
- Specialist
- Accepts Medicare Approved Payment
- PECOS Enrolled
- Medicare Quality Reporting
- CLIA Number: 31D0988032
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 06-18-2027
About OSCAR ORTIZ
This page provides the complete NPI Profile along with additional information for Oscar Ortiz, a provider established in Toms River, New Jersey with a medical specialization in Specialist and more than 44 years of experience. The healthcare provider is registered in the NPI registry with number 1396719662 assigned on February 2006. The practitioner's primary taxonomy code is 174400000X with license number MA06148100 (NJ). The provider is registered as an individual and his NPI record was last updated 6 years ago.
- NPI
- 1396719662
- Provider Name
- DR. OSCAR TANYAG ORTIZ M.D.
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 1163 ROUTE 37 WEST SUITE A-1 TOMS RIVER, NJ 08755
- Location Phone
- (732) 736-1000
- Location Fax
- (732) 736-8811
- Mailing Address
- 1163 ROUTE 37 WEST SUITE A-1 TOMS RIVER, NJ 08755
- Mailing Phone
- (732) 736-1000
- Mailing Fax
- (732) 736-8811
- Medical School Name
- OTHER
- Graduation Year
- 1983
- Is Sole Proprietor?
- No
- Enumeration Date
- 02-14-2006
- Last Update Date
- 03-06-2020
- Code Navigator
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
Specialist
- Taxonomy Code
- 174400000X
- Type
- Other Service Providers
- License No.
- MA06148100
- License State
- NJ
- Taxonomy Description
- An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Medicare Participation & PECOS Enrollment Status
Oscar Ortiz 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.
Oscar Ortiz 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: 7618965526
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: I20040430001142
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
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)
Supplies for maintenance of insulin infusion catheter, per week (HCPCS:A4224)
7 DME suppliers used 64 Medicare Claims 830 Services Paid
DME-Other DME (DE017N)
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each (HCPCS:A4225)
7 DME suppliers used 62 Medicare Claims 1975 Services Paid
DME-Other DME (DE017N)
Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each (HCPCS:A4233)
3 DME suppliers used 25 Medicare Claims 50 Services Paid
DME-Other DME (DE017N)
Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each (HCPCS:A4235)
3 DME suppliers used 22 Medicare Claims 26 Services Paid
DME-Medical/Surgical Supplies (DA000N)
Supply allowance for adjunctive continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service (HCPCS:A4238)
3 DME suppliers used 21 Medicare Claims 21 Services Paid
DME-Other DME (DE017N)
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (HCPCS:A4253)
91 DME suppliers used 851 Medicare Claims 3534 Services Paid
DME-Other DME (DE000N)
Normal, low and high calibrator solution / chips (HCPCS:A4256)
7 DME suppliers used 97 Medicare Claims 97 Services Paid
DME-Other DME (DE000N)
Spring-powered device for lancet, each (HCPCS:A4258)
6 DME suppliers used 40 Medicare Claims 40 Services Paid
DME-Medical/Surgical Supplies (DA000N)
Lancets, per box of 100 (HCPCS:A4259)
65 DME suppliers used 355 Medicare Claims 747 Services Paid
DME-Other DME (DE017N)
Home blood glucose monitor (HCPCS:E0607)
14 DME suppliers used 16 Medicare Claims 16 Services Paid
DME-Other DME (DE017N)
External ambulatory infusion pump, insulin (HCPCS:E0784)
4 DME suppliers used 43 Medicare Claims 43 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)
25 DME suppliers used 1340 Medicare Claims 1356 Services Paid
DME-Other DME (DE017N)
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system (HCPCS:K0554)
11 DME suppliers used 48 Medicare Claims 48 Services Paid
Unknown
Treatment-Injections and Infusions (nononcologic) (RI000N)
Insulin for administration through dme (i.e., insulin pump) per 50 units (HCPCS:J1817)
6 DME suppliers used 18 Medicare Claims 2580 Services Paid
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.
Blood glucose (sugar) test performed by hand-held instrument
Continuous monitoring of blood sugar level in tissue fluid using sensor under skin
Continuous monitoring of blood sugar level in tissue fluid using sensor under skin with interpretation and report
Continuous monitoring of blood sugar level in tissue fluid using sensor under skin with provider supplied equipment
Established patient office or other outpatient visit, 20-29 minutes
Established patient office or other outpatient visit, 30-39 minutes
Established patient office or other outpatient visit, 40-54 minutes
New patient office or other outpatient visit, 30-44 minutes
New patient office or other outpatient visit, 45-59 minutes
Telephone medical discussion with physician, 11-20 minutes
A blood glucose test uses a handheld device to measure the amount of sugar in your blood. A small prick on your finger allows a drop of blood to be placed on a test strip, which is then read by the device. This helps monitor and manage diabetes effectively.
This service was performed 1,385 times for 762 patientsContinuous monitoring of blood sugar involves a small sensor inserted under the skin. This sensor measures glucose levels in tissue fluid throughout the day and night, providing real-time readings. It aids in managing diabetes effectively.
This service was performed 16 times for 15 patientsThis procedure involves placing a small sensor under your skin to continuously monitor your blood sugar levels in tissue fluid. The data is interpreted and a report is generated to help manage your diabetes more effectively.
This service was performed 312 times for 174 patientsThis process involves a tiny sensor placed under your skin that checks your blood sugar levels in tissue fluid regularly. The sensor sends these readings to a device, allowing you to track your levels in real-time. This is provided by your healthcare provider.
This service was performed 19 times for 19 patientsThis is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
This service was performed 553 times for 405 patientsThis is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
This service was performed 1,574 times for 872 patientsThis service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
This service was performed 172 times for 124 patientsThis service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
This service was performed 45 times for 45 patientsThis is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
This service was performed 123 times for 123 patientsThis is a service where you have a phone conversation with your doctor for 11-20 minutes. It's used for discussing health concerns, reviewing test results, or managing ongoing conditions. It's a convenient way to receive medical advice without an in-person visit.
This service was performed 64 times for 56 patientsOverall MIPS Quality Performance
The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 75, 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 Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS 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.
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Final Score: 75 out of 100
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.
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Quality Score: N/A
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 Score: N/A
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. -
Improvement Activities Score: N/A
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 activities measure category compromises 15% providers final MPIS scores.
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. -
Cost Score: 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. -
Cost Score: 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.
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 |
|---|---|---|
| Diabetes: Medical Attention for Nephropathy | 34% | 759 |
| The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period | ||
| Documentation of Current Medications in the Medical Record | 15% | 6027 |
| 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 | 96% | 12603 |
| At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology. | ||
| 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 | 56% | 516 |
| 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 | 55% | 2797 |
| 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 | 39% | 2748 |
| 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 | ||
| 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 | 45% | 2797 |
| 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 | 2% | 2797 |
| 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. | ||
| TCPI Participation | Yes | N/A |
| Participation in the CMS Transforming Clinical Practice Initiative | ||
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. Oscar Ortiz is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| DEBORAH HEART AND LUNG CENTER | 200 TRENTON ROAD BROWNS MILLS, NJ 08015 | (609) 893-6611 | Acute Care Hospitals | |
| COMMUNITY MEDICAL CENTER | 99 RT 37 WEST TOMS RIVER, NJ 08755 | (732) 557-8000 | Acute Care Hospitals | |
| OCEAN MEDICAL CENTER | 425 JACK MARTIN BLVD BRICK, NJ 08724 | (732) 840-2200 | Acute Care Hospitals | |
| MONMOUTH MEDICAL CENTER-SOUTHERN CAMPUS | 600 RIVER AVE LAKEWOOD, NJ 08701 | (732) 363-1900 | Acute Care Hospitals | |
| SOUTHERN OCEAN MEDICAL CENTER | 1140 RT 72 W MANAHAWKIN, NJ 08050 | (609) 597-6011 | Acute Care Hospitals |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 31D0988032
- Facility Type
- Physician Office
- Certificate Effective Date
- June 19, 2025
- Certificate Expiration Date
- June 18, 2027
- Laboratory Director
- OSCAR T. ORTIZ
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Oscar Ortiz to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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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 1396719662, we treat the final digit (2) 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 68. The final step is to find the difference between that total and the next multiple of ten (70 - 68 = 2).
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.
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.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 68 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 2 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1396719662, enumerated as an "individual" on February 14, 2006.
The provider is located at 1163 ROUTE 37 WEST SUITE A-1 TOMS RIVER, NJ 08755 and the phone number is (732) 736-1000.
Specialist with taxonomy code 174400000X.
Oscar Ortiz is affiliated with: DEBORAH HEART AND LUNG CENTER, COMMUNITY MEDICAL CENTER, OCEAN MEDICAL CENTER, MONMOUTH MEDICAL CENTER-SOUTHERN CAMPUS and SOUTHERN OCEAN MEDICAL CENTER.
