ANDREA M DEFELICE NP NPI 1437781416
Nurse Practitioner - Acute Care in Sacramento, CA
About ANDREA M DEFELICE NP
Andrea Defelice is a provider established in Sacramento, California and her medical specialization is Nurse Practitioner with a focus in acute care with more than 4 years of experience. The NPI number of this provider is 1437781416 and was assigned on February 2020. The practitioner's primary taxonomy code is 363LA2100X with license number 95012354 (CA). The provider is registered as an individual and her NPI record was last updated 2 years ago.
| NPI | 1437781416 |
| Provider Name | ANDREA M DEFELICE NP |
| Location Address | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 |
| Location Phone | (916) 679-3590 |
| Mailing Address | 1300 ETHAN WAY STE 600 SACRAMENTO, CA 95825 |
| Gender | Female |
| NPI Entity Type | Individual |
| Medical School Name | OTHER |
| Graduation Year | 2019 |
| Is Sole Proprietor? | No |
| Enumeration Date | 02-07-2020 |
| Last Update Date | 02-01-2021 |
A nurse practitioner (NP) like Andrea Defelice 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.Andrea Defelice 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.
Andrea Defelice is registered with Medicare and accepts claims assignment, this means the provider accepts Medicare's approved amount for the cost of rendered services as full payment. Participating providers may not charge Medicare beneficiaries more than Medicare's approved amount for their services. Medicare beneficiaries still have to pay a coinsurance or copayment amount for a visit or service. According to Medicare claims data she has hospital affiliations with Mercy San Juan Medical Center.
The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 96.44, 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: $23.56 for a new patient copayment and $27.26 for an established patient copayment.
Primary Taxonomy
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
| Taxonomy Code | 363LA2100X |
| Classification | Nurse Practitioner |
| Type | Physician Assistants & Advanced Practice Nursing Providers |
| Specialization | Acute Care |
| License No. | 95012354 |
| License State | CA |
Business Address
1508 ALHAMBRA BLVD STE 200
SACRAMENTO, CA
ZIP 95816
Phone: (916) 679-3590
Fax: (916) 482-3647
Mailing Address
1300 ETHAN WAY STE 600
SACRAMENTO, CA
ZIP 95825
Phone: (916) 482-7623
Secondary Locations
5525 Etiwanda Ave Ste 320
Tarzana, CA 91356
(818) 774-38385 Medical Plaza Dr Ste 190
Roseville, CA 95661
(916) 679-3590
Location Map
PECOS Enrollment and Medicare Participation Status
What is PECOS?
PECOS is the Medicare Provider, Enrollment, Chain and Ownership System. PECOS is Medicare's enrollment and revalidation system and it is the primary source of information about verified Medicare professionals. A NPI number is necessary to register in PECOS. Providers must enroll in PECOS to avoid denied claims.
| Registered in PECOS? | Yes |
| PECOS PAC ID | 8426486119 |
| PECOS Enrollment ID | I20200311001275 |
| 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 order / refer Part B Clinical Laboratory and Imaging | Yes |
| Eligible order / refer Durable Medical Equipment | Yes |
| Eligible order / refer Home Health Agency (HHA) | Yes |
| Eligible order / refer Power Mobility Devices | Yes |
Physician Office Visit Costs
The provider accepts as payment the Medicare approved amount. Medicare beneficiaries should not be billed for more than the Medicare deductible and coinsurance amounts. Medicare pricing is usually a reference point for private insurance covered patients. The prices below reflect the costs for new and established patients in the 95816 ZIP code area.
| New Patients Office Visits Costs * | ||
|---|---|---|
| Most Utilized Procedure Code for new patients office visits: 99203 | ||
| Minimum New Patient Pricing | Maximum New Patient Pricing | Typical New Patient Pricing |
| $61.52 | $185.29 | $94.24 |
| Minimum New Patient Copayment | Maximum New Patient Copayment | Typical New Patient Copayment |
| $15.38 | $46.32 | $23.56 |
| Established Patients Office Visits Costs * | ||
|---|---|---|
| Most Utilized Procedure Code for established patients office visits: 99214 | ||
| Minimum Established Patient Pricing | Maximum Established Patient Pricing | Typical Established Patient Pricing |
| $19.52 | $151.94 | $109.06 |
| Minimum Established Patient Copayment | Maximum Established Patient Copayment | Typical Established Patient Copayment |
| $4.88 | $37.98 | $27.26 |
* The physician office visit costs information is obtained by Medicare's 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 Medicare's 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.
| MIPS Measure | Score Weight | Score | |
|---|---|---|---|
| Quality | 40% | 93.52 | |
|
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 (PI) | 25% | 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 | 15% | 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 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 | 20% | 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. |
|||
| MIPS Final Score | - | 96.44 | |
| 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. | |||
Clinician Utilization
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 2017. The reported codes are based on the top 5 codes for each available Medicare specialty, excluding evaluation and management codes.
- 11Vaccine for influenza for injection into muscle (HCPCS:90662)
- 11Administration of influenza virus vaccine (HCPCS:G0008)
Hospital Affiliations
Medicare hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the Medicare 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. Andrea Defelice is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | CMS Certification Number (CCN) | Overall Rating |
|---|---|---|---|---|---|
| MERCY SAN JUAN MEDICAL CENTER | 6501 COYLE AVE CARMICHAEL, CA 95608 | (916) 537-5000 | Acute Care Hospitals | 50516 |
Secondary Taxonomies
The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.
| No. | Taxonomy Code | Type | Classification | Specialization | License No. | State | Primary |
|---|---|---|---|---|---|---|---|
| 1 | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 95012354 | CA | No | |
Taxonomy Description: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. | |||||||
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. | |||||||||
| 1 | 4 | 3 | 7 | 7 | 8 | 1 | 4 | 1 | 6 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 4 | 6 | 7 | 14 | 8 | 2 | 4 | 2 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 4 + 6 + 7 + 1 + 4 + 8 + 2 + 4 + 2 + 24 = 64 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 64 = 6 | 6 | ||||||||
The NPI number 1437781416 is valid because the calculated check digit 6 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 |
|---|---|---|---|
| 1912949132 | RICHARD THOMAS KIM M.D. Individual | Internal Medicine (Critical Care Medicine) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 325-1040 |
| 1730124520 | DANIEL PHILIP IKEDA M.D. Individual | Internal Medicine (Critical Care Medicine) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 325-1040 |
| 1689600553 | MUHAMMAD AFZAL M.D. Individual | Internal Medicine (Critical Care Medicine) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 325-1040 |
| 1063458495 | RICHARD DAVID DEFELICE M.D. Individual | Internal Medicine (Critical Care Medicine) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 325-1040 |
| 1831127570 | DR. IMRAN AURANGZEB M.D. Individual | Internal Medicine (Critical Care Medicine) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 679-3590 |
| 1811927429 | GHOLAMHOSSAIN HAYAT M.D. Individual | Internal Medicine (Pulmonary Disease) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 325-1040 |
| 1861418543 | ALAN RUSSELL YEE M.D. Individual | Internal Medicine (Pulmonary Disease) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 325-1040 |
| 1255359378 | PULMONARY MEDICINE ASSOCIATES SLEEP LAB INC. Organization | Clinic/Center (Sleep Disorder Diagnostic) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 325-1040 |
| 1558385997 | DR. KAPIL DHAWAN M.D. Individual | Internal Medicine (Critical Care Medicine) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 325-1040 |
| 1093912958 | DR. SAMAN HAYATDAVOUDI M.D. Individual | Internal Medicine (Critical Care Medicine) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 325-1040 |
| 1003001645 | VINOD TRIVEDI MD Individual | Internal Medicine (Infectious Disease) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 325-1040 |
| 1750561452 | DR. BRADLEY WAYNE SCHROEDER MD, PHD Individual | Internal Medicine (Critical Care Medicine) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 325-1040 |
| 1356506372 | DR. BRETT RYAN LAURENCE MD Individual | Internal Medicine (Infectious Disease) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 325-1040 |
| 1063731966 | DR. NATHANIEL GORDON MD Individual | Internal Medicine (Critical Care Medicine) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 679-3590 |
| 1831456086 | DR. MANDEEP KAUR GREWAL M.D. Individual | Internal Medicine (Critical Care Medicine) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 679-3590 |
| 1366761496 | NATHANIEL RICHARD DEFELICE M.D. Individual | Internal Medicine (Critical Care Medicine) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 679-3590 |
| 1417184078 | DR. RAVNEET RIAR M.D. Individual | Internal Medicine (Pulmonary Disease) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 679-3590 |
| 1326420043 | HIMA BINDU VENIGANDLA D.O. Individual | Internal Medicine (Critical Care Medicine) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 679-3590 |
| 1851788665 | SEAN M GUNTHER MAHER MD Individual | Internal Medicine (Critical Care Medicine) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 325-1040 |
| 1083265565 | RAJWINDER KAUR FNP Individual | Nurse Practitioner (Family) | 1508 ALHAMBRA BLVD STE 200 SACRAMENTO, CA 95816 (916) 325-1040 |
Frequently Asked Questions
What is Andrea Defelice NP NPI number?
The NPI number assigned to this healthcare provider is 1437781416, registered as an "individual" on February 07, 2020
Where is Andrea Defelice NP located?
The provider is located at 1508 Alhambra Blvd Ste 200 Sacramento, Ca 95816 and the phone number is (916) 679-3590
Which is Andrea Defelice NP specialty?
The provider's speciality is Nurse Practitioner with a focus in Acute Care
How many years of experience does Andrea Defelice NP have?
The provider has more than 4 years of experience.
Is Andrea Defelice NP registered in PECOS?
Yes, as of May 11, 2023 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a Medicare 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.
What are Andrea Defelice NP Quality Ratings?
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.
How much is a visit to Andrea Defelice NP?
Medicare beneficiaries should expect a typical cost of $94.24 with an average copayment of $23.56 for new patient appointments. Established patients should expect a typical charge of $109.06 and an average copayment of 27.26. Please review your insurance plan or contact the provider directly to determine your specific costs.
What are some of the services provided by Andrea Defelice NP?
The most common procedures or services performed by this practitioner are: Vaccine for influenza for injection into muscle and Administration of influenza virus vaccine.
Is Andrea Defelice NP affiliated to any hospitals?
The practitioner is affiliated to the following hospitals: MERCY SAN JUAN MEDICAL CENTER. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
How do I update my NPI information?
The NPI record of Andrea Defelice NP was last updated on February 07, 2020. 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.