MARLON D SHELBY PA
NPI 1447313630
Physician Assistant in Chester, SC

NPI Status: Active since December 18, 2006

Contact Information

517 DOCTORS CT
CHESTER, SC
ZIP 29706
Phone: (803) 581-2800
Fax: (803) 581-4396

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Medicare Participation & PECOS Status
Durable Medical Equipment
Physician Visit Costs
Quality Reporting
Hospital Affiliations - Privileges
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Male
Years of Experience 27
Physician Assistant
Accepts Insurance
Accepts Medicare Approved Payment
PECOS Enrolled
Medicare Quality Reporting

About MARLON SHELBY

This page provides the complete NPI Profile along with additional information for Marlon Shelby, a primary care provider established in Chester, South Carolina with a medical specialization in Physician Assistant and more than 27 years of experience. He graduated from Medical University Of South Carolina College Of Medicine in 1999. The healthcare provider is registered in the NPI registry with number 1447313630 assigned on December 2006. The practitioner's primary taxonomy code is 363A00000X with license number 608 (SC). The provider is registered as an individual and his NPI record was last updated 7 years ago.

NPI: 1447313630
Provider Name: MARLON D SHELBY PA
Gender: Male
Entity Type: Individual
Location Address: 517 DOCTORS CT CHESTER, SC 29706
Location Phone: (803) 581-2800
Location Fax: (803) 581-4396
Mailing Address: PO BOX 603898 CHARLOTTE, NC 28260
Mailing Phone: (803) 581-2800
Mailing Fax: (803) 581-4396
Medical School Name: MEDICAL UNIVERSITY OF SOUTH CAROLINA COLLEGE OF MEDICINE
Graduation Year: 1999
Is Sole Proprietor?: No
Enumeration Date: 12-18-2006
Last Update Date: 05-13-2019
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A primary care provider (PCP) like Marlon Shelby sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc

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: Physician Assistant
Taxonomy Code: 363A00000X
Type: Physician Assistants & Advanced Practice Nursing Providers
License No.: 608
License State: SC
Taxonomy Description: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Insurance Plans Accepted

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

BlueCross BlueShield of South Carolina

Blue Beaufort Bronze 1 - HMO
Blue Beaufort Bronze 2 - HMO
Blue Beaufort Gold 1 - HMO
Blue Beaufort Silver 1 - HMO
Blue Beaufort Silver 2 - HMO
Blue Beaufort Silver 2 + Adult Vision - HMO
Blue Beaufort Standard Expanded Bronze - HMO
Blue Beaufort Standard Gold - HMO
Blue Beaufort Standard Silver - HMO
Blue Congaree Bronze 1 - HMO

First Choice Next

First Choice Next Bronze Essential - HMO
First Choice Next Bronze Premier - HMO
First Choice Next Bronze Signature - HMO
First Choice Next Gold Premier - HMO
First Choice Next Gold Signature - HMO
First Choice Next Silver Essential - HMO
First Choice Next Silver Premier - HMO
First Choice Next Silver Signature - HMO

Molina Healthcare

Molina Gold Core 1640 - HMO
Molina Gold Core 1640 Plus with Adult Dental and Vision - HMO
Molina Gold Core 1640 Plus with Adult Vision - HMO
Molina Gold Standard - HMO
Molina Gold Value - HMO
Molina Gold Value Plus with Adult Dental and Vision - HMO
Molina Gold Value Plus with Adult Vision - HMO
Molina Silver Core - HMO
Molina Silver Core Plus with Adult Dental and Vision - HMO
Molina Silver Core Plus with Adult Vision - HMO

UnitedHealthcare

UHC Bronze Copay Focus $0 Indiv Med Ded - HMO
UHC Bronze Copay Focus+ $0 Indiv Med Ded (Dental + Vision) - HMO
UHC Bronze Essential - HMO
UHC Bronze Essential- - HMO
UHC Bronze Standard - HMO
UHC Bronze Standard Plus Chiro - HMO
UHC Gold Advantage - HMO
UHC Gold Advantage+ (Dental + Vision) - HMO
UHC Gold Copay Focus $0 Indiv Med Ded - HMO
UHC Gold Standard - HMO

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*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
104247	MEDICAID (05)	SC

Medicare Participation & PECOS Enrollment Status

Marlon Shelby 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.

Marlon Shelby 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: 3375431422
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: I20040309001107
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)
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (HCPCS:A4253)
5 DME suppliers used 17 Medicare Claims 32 Services Paid
DME-Oxygen and Supplies (DC002N)
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)
1 DME suppliers used 12 Medicare Claims 12 Services Paid
DME-Oxygen and Supplies (DC002N)
Portable oxygen concentrator, rental (HCPCS:E1392)
1 DME suppliers used 12 Medicare Claims 12 Services Paid
DME-Wheelchairs (DD000N)
Standard wheelchair (HCPCS:K0001)
1 DME suppliers used 11 Medicare Claims 11 Services Paid
DME-Wheelchairs (DD021N)
Elevating leg rests, pair (for use with capped rental wheelchair base) (HCPCS:K0195)
1 DME suppliers used 11 Medicare Claims 11 Services Paid
DME-Other DME (DE000N)
Pharmacy dispensing fee for inhalation drug(s); per 30 days (HCPCS:Q0513)
3 DME suppliers used 13 Medicare Claims 13 Services Paid

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $20.79 for a new patient copayment and $16.78 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 29706 ZIP code area.

New Patients Visit Costs *

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

Average New Patient Price $83.18
Minimum New Patient Price $53.57
Maximum New Patient Price $163.84

Average New Patient Copayment $20.79
Minimum New Patient Copayment $13.39
Maximum New Patient Copayment $40.96

Established Patients Visit Costs *

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

Average Established Patient Price $67.12
Minimum Established Patient Price $16.96
Maximum Established Patient Price $133.52

Average Established Patient Copayment $16.78
Minimum Established Patient Copayment $4.24
Maximum Established Patient Copayment $33.38

* 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.

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
Breast Cancer Screening	69%	254
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
Chronic Care and Preventative Care Management for Empaneled Patients	Yes	N/A
Proactively manage chronic and preventive care for empaneled patients that could include one or more of the following: • Provide patients annually with an opportunity for development and/or adjustment of an individualized plan of care as appropriate to age and health status, including health risk appraisal; gender, age and condition-specific preventive care services; and plan of care for chronic conditions; • Use condition-specific pathways for care of chronic conditions (e.g., hypertension, diabetes, depression, asthma and heart failure) with evidence-based protocols to guide treatment to target; such as a CDC-recognized diabetes prevention program; • Use pre-visit planning to optimize preventive care and team management of patients with chronic conditions; • Use panel support tools (registry functionality) to identify services due; • Use predictive analytical models to predict risk, onset and progression of chronic diseases; or • Use reminders and outreach (e.g., phone calls, emails, postcards, patient portals and community health workers where available) to alert and educate patients about services due; and/or routine medication reconciliation.
Colorectal Cancer Screening	43%	631
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
Diabetes: Eye Exam	32%	210
Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period
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.
Measurement and Improvement at the Practice and Panel Level	Yes	N/A
Measure and improve quality at the practice and panel level, such as the American Board of Orthopaedic Surgery (ABOS) Physician Scorecards, that could include one or more of the following: • Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice level and at the level of the care team or MIPS eligible clinician or group (panel); and/or • Use relevant data sources to create benchmarks and goals for performance at the practice level and panel level.
Use of decision support and standardized treatment protocols	Yes	N/A
Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs.

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. Marlon Shelby is affiliated with the following medical facilities:

Hospital Name	Address	Phone	Hospital Type	Overall Rating
MUSC HEALTH CHESTER MEDICAL CENTER	1 MEDICAL PARK DRIVE CHESTER, SC 29706	(803) 581-3151	Acute Care Hospitals
MUSC HEALTH LANCASTER MEDICAL CENTER	800 W MEETING ST LANCASTER, SC 29720	(803) 286-1481	Acute Care Hospitals

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 1447313630, we treat the final digit (0) 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 70. The final step is to find the difference between that total and the next multiple of ten (70 - 70 = 0).

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.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 8

Pos 4

Unchanged

Pos 5

Doubled → 6

Pos 6

Unchanged

Pos 7

Doubled → 6

Pos 8

Unchanged

Pos 9

Doubled → 6

Check

Target digit

Regular digit Doubled digit Check digit

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.

1 → 2 4 → 8 3 → 6 3 → 6 3 → 6

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 4 + 8 + 7 + 6 + 1 + 6 + 6 + 6 + 24 = 70

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 70 is 70. The difference is the calculated check digit.

70 - 70 = 0

This NPI is valid

The calculated check digit is 0, which matches the last digit of 1447313630.