MR. SHUJAUDDIN N VALIKA M.D.
NPI 1417908724
Internal Medicine - Endocrinology, Diabetes & Metabolism in Hoffman Estates, IL

Medicare Participation & PECOS Enrollment Status

Shujauddin Valika 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.

Shujauddin Valika 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: 8022029495

  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: I20100917000696

  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)

  8 DME suppliers used 167 Medicare Claims 2123 Services Paid

• DME-Other DME (DE017N)

  Supplies for external insulin infusion pump, syringe type cartridge, sterile, each (HCPCS:A4225)

  8 DME suppliers used 166 Medicare Claims 5343 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)

  6 DME suppliers used 87 Medicare Claims 101 Services Paid

• DME-Other DME (DE017N)

  Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (HCPCS:A4253)

  41 DME suppliers used 199 Medicare Claims 1039 Services Paid

• DME-Medical/Surgical Supplies (DA000N)

  Lancets, per box of 100 (HCPCS:A4259)

  17 DME suppliers used 54 Medicare Claims 130 Services Paid

• DME-Other DME (DE017N)

  External ambulatory infusion pump, insulin (HCPCS:E0784)

  7 DME suppliers used 130 Medicare Claims 130 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)

  16 DME suppliers used 877 Medicare Claims 878 Services Paid

• DME-Other DME (DE017N)

  Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system (HCPCS:K0554)

  6 DME suppliers used 37 Medicare Claims 37 Services Paid

Unknown

• Treatment-Injections and Infusions (nononcologic) (RI000N)

  Insulin for administration through dme (i.e., insulin pump) per 50 units (HCPCS:J1817)

  29 DME suppliers used 220 Medicare Claims 23360 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

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 407 times for 183 patients

Blood test, thyroid stimulating hormone (tsh)

A TSH blood test measures the level of thyroid stimulating hormone in your body. This hormone is produced by the pituitary gland and regulates how your thyroid works. It's a simple procedure where a small amount of blood is drawn from your arm for analysis.

This service was performed 17 times for 17 patients

Continuous monitoring of blood sugar level in tissue fluid using sensor under skin

Continuous 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 67 times for 62 patients

Continuous monitoring of blood sugar level in tissue fluid using sensor under skin with interpretation and report

This 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 292 times for 109 patients

Continuous monitoring of blood sugar level in tissue fluid using sensor under skin with provider supplied equipment

This 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 23 times for 23 patients

Established patient office or other outpatient visit, 30-39 minutes

This 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 944 times for 339 patients

New patient office or other outpatient visit, 45-59 minutes

This 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 26 times for 26 patients

Telephone medical discussion with physician, 11-20 minutes

This 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 17 times for 17 patients

Telephone medical discussion with physician, 21-30 minutes

This service involves a 21-30 minute phone conversation with a physician. It's a chance for you to discuss your health concerns, symptoms or treatment plans. It's similar to an in-person consultation, but conducted over the phone for your convenience and safety.

This service was performed 16 times for 15 patients

Testing of autonomic (sympathetic) nervous system function

Testing of autonomic nervous system function assesses how well your body's automatic processes, like heart rate and blood pressure, are working. It involves various non-invasive tests like heart rate variability and sweat production tests.

This service was performed 25 times for 25 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $34.71 for a new patient copayment and $26.42 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 60169 ZIP code area.

* 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.

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. Shujauddin Valika is affiliated with the following medical facilities:

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Frequently Asked Questions