DR. WILLIAM W CULBERTSON MD
NPI 1437126778
Ophthalmology in Miami, FL


Quality Rating: 91.28 out of 100 score

NPI Status: Active since March 07, 2006

Contact Information

1611 NW 12TH AVE
M851
MIAMI, FL
ZIP 33136
Phone: (305) 243-7688

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  • Individual
  • Male
  • Years of Experience 54
  • Ophthalmology
  • PECOS Enrolled
  • Accepts Medicare Approved Payment

About WILLIAM CULBERTSON

William Culbertson is a provider established in Miami, Florida and his medical specialization is Ophthalmology with more than 54 years of experience. He graduated from Emory University School Of Medicine in 1970. The healthcare provider is registered in the NPI registry with number 1437126778 assigned on March 2006. The practitioner's primary taxonomy code is 207W00000X with license number ME22067 (FL). The provider is registered as an individual and his NPI record was last updated 17 years ago.

NPI
1437126778
Provider Name
DR. WILLIAM W CULBERTSON MD
Gender
Male
Entity Type
Individual
Location Address
1611 NW 12TH AVE M851 MIAMI, FL 33136
Location Phone
(305) 243-7688
Mailing Address
1611 NW 12TH AVE MIAMI, FL 33136
Mailing Phone
(305) 243-7688
Medical School Name
EMORY UNIVERSITY SCHOOL OF MEDICINE
Graduation Year
1970
Is Sole Proprietor?
Yes
Enumeration Date
03-07-2006
Last Update Date
07-08-2007
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Ophthalmologists like William Culbertson specialize in diagnosing and treating eye conditions. They may perform surgeries to correct vision issues or prevent vision loss due to diseases like glaucoma. Additionally, they can provide eyeglasses, prescribe contact lenses, and offer other vision-related services.

William Culbertson 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 provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 91.28, 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 typical physician office visit costs for Medicare beneficiaries in this area are: $36.92 for a new patient copayment and $19.83 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

Ophthalmology

Taxonomy Code
207W00000X
Type
Allopathic & Osteopathic Physicians
License No.
ME22067
License State
FL
Taxonomy Description
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.

Insurance Plans Accepted

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

  • Aetna CVS Health

    • Bronze 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
    • Bronze S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
    • Gold 3: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
    • Gold 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
    • Gold S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
  • Ambetter from Peach State Health Plan

    • Choice Bronze HSA - HMO
    • Choice Bronze HSA + Vision + Adult Dental - HMO
    • Clear Bronze - HMO
    • Clear Bronze + Vision + Adult Dental - HMO
    • Clear Gold - HMO
  • Ambetter from Sunshine Health

    • Ambetter Virtual Access Bronze (Virtual PCP selection required) - HMO
    • Ambetter Virtual Access Gold (Virtual PCP selection required) - HMO
    • Ambetter Virtual Access Silver (Virtual PCP selection required) - HMO
    • Choice Bronze HSA - EPO
    • Choice Bronze HSA + Vision + Adult Dental - EPO
  • Ambetter of Alabama

    • Choice Bronze HSA - EPO
    • Choice Bronze HSA + Vision + Adult Dental - EPO
    • Clear Silver - EPO
    • Clear Silver + Vision + Adult Dental - EPO
    • Elite Bronze - EPO
  • AvMed

    • AvMed Entrust Bronze 600 (2024) - HMO
    • AvMed Entrust Bronze 625 Dental+Vision (2024) - HMO
    • AvMed Entrust Bronze 650 (2024) - HMO
    • AvMed Entrust Expanded Bronze Standard (2024) - HMO
    • AvMed Entrust Gold 125 (2024) - HMO
  • Florida Blue (BlueCross BlueShield FL)

    • BlueOptions Bronze (HSA) 24J01-10 (Rewards $$$ / $4 Condition Care Rx) - PPO
    • BlueOptions Bronze 24J01-04 ($0 Virtual Visits / 3 PCP Visits for $0 then $40 / Rewards $$$) - PPO
    • BlueOptions Bronze 24J01-06 ($0 Virtual Visits / Rewards $$$) - PPO
    • BlueOptions Bronze 24J01-17 ($0 Virtual Visits / $50 PCP Visits / Rewards $$$) - PPO
    • BlueOptions Bronze 24J01-18S (Multilingual Available / Rewards $$$) - PPO
  • Molina Healthcare

    • Bronze 4 - HMO
    • Bronze 8 - HMO
    • Gold 1 - HMO
    • Gold 1 with Adult Vision Services - HMO
    • Gold 8 - HMO
  • Oscar Insurance Company of Florida

    • Bronze Classic - EPO
    • Bronze Classic 4700 - EPO
    • Bronze Classic Standard - EPO
    • Bronze Elite + PCP Saver Plus - EPO
    • Bronze Elite + Specialist Saver Plus - EPO
  • Medicare

  • Medicaid


*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 Identifier Issuer
D59878MEDICARE UPIN (02)FL 
91960MEDICARE ID-TYPE UNSPECIFIED (04)FL 

PECOS Enrollment and Medicare Participation Status

William Culbertson 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: 5597957704

    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: I20101006000897

    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 33136 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99204

  • Average New Patient Price $147.71
  • Minimum New Patient Price $63.97
  • Maximum New Patient Price $195.27
  • Average New Patient Copayment $36.92
  • Minimum New Patient Copayment $15.99
  • Maximum New Patient Copayment $48.81

Established Patients Visit Costs *

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

  • Average Established Patient Price $79.32
  • Minimum Established Patient Price $19.18
  • Maximum Established Patient Price $157.53
  • Average Established Patient Copayment $19.83
  • Minimum Established Patient Copayment $4.79
  • Maximum Established Patient Copayment $39.38

* 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.

Overall MIPS Quality 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.

  • Final Score: 91.28 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.

  • Quality Score: 84.16

    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.

  • Promoting Interoperability Score: 100

    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: 40

    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.

Clinician Services

The following Healthcare Common Procedure Coding System (HCPCS) codes were publicly reported as the top services rendered by this provider under the Medicare program for the year 2020. The reported codes are based on the top 5 codes for each available specialty, excluding evaluation and management codes.

  • 135

    Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits (HCPCS:92014)

  • 63

    Eye and medical examination for diagnosis and treatment, established patient (HCPCS:92012)

  • 28

    Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits (HCPCS:92004)

  • 16

    Diagnostic imaging of retina (HCPCS:92134)

Reviews for DR. WILLIAM W CULBERTSON MD

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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.
1437126778
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
24672212714
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 4 + 6 + 7 + 2 + 2 + 1 + 2 + 7 + 1 + 4 + 24 = 62
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 62 = 88

The NPI number 1437126778 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 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1740286251 KAREN CHITTY MD
Individual
Emergency Medicine1611 NW 12TH AVE
MIAMI, FL 33136
(305) 585-6913
1598761793MS. DEBRA JEANNE DIAZ CRNA
Individual
Nurse Anesthetist, Certified Registered1611 NW 12TH AVE
MIAMI, FL 33136
(305) 585-8684
1861498891 VALERIE DIAZ CRNA
Individual
Nurse Anesthetist, Certified Registered1611 NW 12TH AVE
MIAMI, FL 33136
(305) 585-6586
1386640282DR. SCOTT KOHL DO
Individual
Emergency Medicine1611 NW 12TH AVE
MIAMI, FL 33136
(954) 709-0966
1184620726MISS NATASHA ELISE ROBINSON PHARM.D.
Individual
Pharmacist (Pharmacotherapy)1611 NW 12TH AVE
MIAMI, FL 33136
(305) 585-7096
1376540971DR. JAY B.B. BLAKE PHARM.D.
Individual
Pharmacist (Pharmacotherapy)1611 NW 12TH AVE
MIAMI, FL 33136
(305) 585-7195
1578563565DR. CAMERON DEZFULIAN MD
Individual
Pediatrics (Pediatric Critical Care Medicine)1611 NW 12TH AVE
MIAMI, FL 33136
(305) 585-1111
1255326930DR. GINA ELIZABETH WHITE PHARM.D.
Individual
Pharmacist (Pharmacotherapy)1611 NW 12TH AVE PHARMACY DEPARTMENT
MIAMI, FL 33136
(305) 585-8906
1073509626DR. AYANNA D PHILLIPS PHARM.D.
Individual
Pharmacist (Pharmacotherapy)1611 NW 12TH AVE JACKSON MEMORIAL HOSPITAL PHARMACY DEPARTMENT
MIAMI, FL 33136
(305) 585-7308
1841272077MR. ABDUL MAJID MEMON MD
Individual
Emergency Medicine1611 NW 12TH AVE ECC ET 1195
MIAMI, FL 33136
(305) 585-6913
1548246259 ANDREW ERIC ROSENBERG MD
Individual
Pathology (Anatomic Pathology)1611 NW 12TH AVE
MIAMI, FL 33136
(305) 585-6303
1316917321DR. JOHN EDWARD SULLIVAN M.D.
Individual
Emergency Medicine1611 NW 12TH AVE JACKSON MEMORIAL HOSPITAL
MIAMI, FL 33136
(305) 585-7872
1477525897 LOAY SALMAN MD
Individual
Internal Medicine (Nephrology)1611 NW 12TH AVE BOX 016960 M851
MIAMI, FL 33136
(305) 585-1111
1437124534MS. CHIFFON ROCHELLE HOLIDAY ARNP
Individual
Nurse Practitioner (Family)1611 NW 12TH AVE
MIAMI, FL 33136
(954) 885-0443
1982670741MRS. MARIA SOCORRO TORRES-BURGOS ARNP
Individual
Nurse Practitioner1611 NW 12TH AVE
MIAMI, FL 33136
(305) 585-8946
1265408058 ANGELA ROSE BURRAFATO M.D.
Individual
Internal Medicine1611 NW 12TH AVE
MIAMI, FL 33136
(305) 585-6524
1114993755MR. DOUGLAS EUGENE HOUGHTON JR. ARNP
Individual
Nurse Practitioner (Critical Care Medicine)1611 NW 12TH AVE JACKSON HEALTH SYSTEM
MIAMI, FL 33136
(305) 585-1168
1184691008MRS. RHONDA JANE SMITH RN, MSN, ARNP
Individual
Nurse Practitioner (Adult Health)1611 NW 12TH AVE
MIAMI, FL 33136
(305) 585-6538
1821066440 MONICA A. LUFT CRNA
Individual
Nurse Anesthetist, Certified Registered1611 NW 12TH AVE SOUTH WING RM 300
MIAMI, FL 33136
(305) 585-8684
1902865264 JAVIER ROMERO
Individual
Registered Nurse1611 NW 12TH AVE
MIAMI, FL 33136
(305) 585-6586

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1437126778, enumerated in the NPI registry as an "individual" on March 07, 2006

The provider is located at 1611 Nw 12th Ave M851 Miami, Fl 33136 and the phone number is (305) 243-7688

The provider's speciality is Ophthalmology with taxonomy code 207W00000X

The provider has more than 54 years of experience. He graduated from Emory University School Of Medicine in 1970.

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

Yes, as of June 14, 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.

The provider has an overall high rating in the following quality measures: quality clinical practices and patient outcomes and experiences , uses technology to exchange and make use of healthcare information.

Medicare beneficiaries should expect a typical cost of $147.71 with an average copayment of $36.92 for new patient appointments. Established patients should expect a typical charge of $79.32 and an average copayment of 19.83. Please review your insurance plan or contact the provider directly to determine your specific costs.

The most common procedures or services performed by this practitioner are: Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits, Eye and medical examination for diagnosis and treatment, established patient, Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits and Diagnostic imaging of retina.

This NPI record was last updated on March 07, 2006. 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.