DR. MASAYA HIGUCHI M.D.
NPI 1457544892
Family Medicine in Boston, MA

NPI Status: Active since August 20, 2007

Contact Information

165 CAMBRIDGE ST STE 502
BOSTON, MA
ZIP 02114
Phone: (617) 726-4600

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  • Individual
  • Male
  • Years of Experience 21
  • Family Medicine
  • Accepts Insurance
  • Accepts Medicare Approved Payment
  • PECOS Enrolled

About MASAYA HIGUCHI

This page provides the complete NPI Profile along with additional information for Masaya Higuchi, a primary care provider established in Boston, Massachusetts with a medical specialization in Family Medicine and more than 21 years of experience. The healthcare provider is registered in the NPI registry with number 1457544892 assigned on August 2007. The practitioner's primary taxonomy code is 207Q00000X with license number 275558 (MA). The provider is registered as an individual and his NPI record was last updated 5 years ago.

NPI
1457544892
Provider Name
DR. MASAYA HIGUCHI M.D.
Gender
Male
Entity Type
Individual
Location Address
165 CAMBRIDGE ST STE 502 BOSTON, MA 02114
Location Phone
(617) 726-4600
Mailing Address
165 CAMBRIDGE ST STE 502 BOSTON, MA 02114
Mailing Phone
(617) 726-4600
Medical School Name
OTHER
Graduation Year
2005
Is Sole Proprietor?
No
Enumeration Date
08-20-2007
Last Update Date
12-08-2020
Code Navigator

A primary care provider (PCP) like Masaya Higuchi 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

Secondary Locations

  • 520 N 4th St
    Springfield, IL 62702
    (217) 757-8100

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

Family Medicine

Taxonomy Code
207Q00000X
Type
Allopathic & Osteopathic Physicians
License No.
275558
License State
MA
Taxonomy Description
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1207Q00000XAllopathic & Osteopathic Physicians

Family Medicine

036-129268 (KS)

Insurance Plans Accepted

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

  • Anthem Bronze Access Blue New England HMO 5000/10%/8000 w/HSA - HMO
  • Anthem Bronze Access Blue New England HMO 5000/20%/8000 w/HSA - HMO
  • Anthem Bronze Access Blue New England HMO 6500/30%/9200 Value - HMO
  • Anthem Bronze Access Blue New England HMO 7000/50%/8000 w/HSA - HMO
  • Anthem Bronze Access Blue New England HMO 8500/50%/9200 - HMO
  • Anthem Gold Access Blue New England HMO 1000/20%/7500 - HMO
  • Anthem Gold Access Blue New England HMO 2000/0%/6500 RxD - HMO
  • Anthem Gold Access Blue New England HMO 2000/10%/4600 w/HSA - HMO
  • Anthem Gold Access Blue New England HMO 2000/10%/7500 - HMO
  • Anthem Gold Access Blue New England HMO 2000/20%/4600 w/HSA - HMO
  • Anthem Gold Access Blue New England HMO 3000/0%/5500 RxD - HMO
  • Anthem Gold Access Blue New England HMO 500/25%/7000 - HMO
  • Anthem Platinum Access Blue New England HMO 250/10%/3500 - HMO
  • Anthem Silver Access Blue New England HMO 2000/30%/9000 Value - HMO
  • Anthem Silver Access Blue New England HMO 3000/20%/8500 - HMO
  • Anthem Silver Access Blue New England HMO 3000/30%/9000 Value - HMO
  • Anthem Silver Access Blue New England HMO 3500/20%/7250 w/HSA - HMO
  • Anthem Silver Access Blue New England HMO 4000/0%/8500 - HMO
  • Anthem Silver Access Blue New England HMO 4000/0%/8500 RxD - HMO
  • Anthem Silver Access Blue New England HMO 4000/10%/7250 w/HSA - HMO

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

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
036129268MEDICAID (05)IL 

Medicare Participation & PECOS Enrollment Status

Masaya Higuchi 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.

Masaya Higuchi 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: 6608023874

    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: I20180816001823

    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-Medical/Surgical Supplies (DA000N)

    Tape, non-waterproof, per 18 square inches (HCPCS:A4450)

    1 DME suppliers used 11 Medicare Claims 1260 Services Paid

  • DME-Hospital Beds (DB000N)

    Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress (HCPCS:E0260)

    1 DME suppliers used 16 Medicare Claims 16 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)

    2 DME suppliers used 19 Medicare Claims 19 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.

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 183 times for 110 patients

Established patient office or other outpatient visit, 40-54 minutes

This 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 87 times for 66 patients

Follow-up hospital inpatient care per day, typically 25 minutes

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

This service was performed 286 times for 111 patients

Follow-up nursing facility visit per day, typically 25 minutes

A follow-up nursing facility visit per day is a daily check-in by a healthcare professional. This 25-minute visit typically involves monitoring your health progress, addressing any concerns, and adjusting treatment plans as necessary. It's a vital part of ensuring your ongoing wellbeing.

This service was performed 168 times for 27 patients

Initial hospital inpatient care per day, typically 70 minutes

Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.

This service was performed 60 times for 60 patients

Insertion of needle into vein for collection of blood sample

This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.

This service was performed 56 times for 49 patients

Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and

This is a service where a doctor or authorized practitioner certifies that you require Medicare-covered home health services. They will communicate with the home health agency and review reports on your health status to ensure you receive appropriate care. This does not involve an in-person visit.

This service was performed 16 times for 13 patients

Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or

This service refers to extended doctor visits where your healthcare provider spends additional time evaluating and managing your health beyond the primary procedure's required time. This includes each extra 15 minutes spent by the physician on the same day as the primary service.

This service was performed 76 times for 26 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 59 times for 49 patients

Physician Visit Costs



The typical physician office visit costs for Medicare beneficiaries in this area are: $24.41 for a new patient copayment and $27.79 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 02114 ZIP code area.

New Patients Visit Costs *

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

  • Average New Patient Price $97.64
  • Minimum New Patient Price $63.72
  • Maximum New Patient Price $189.86
  • Average New Patient Copayment $24.41
  • Minimum New Patient Copayment $15.93
  • Maximum New Patient Copayment $47.46

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

  • Average Established Patient Price $111.18
  • Minimum Established Patient Price $21.07
  • Maximum Established Patient Price $155.29
  • Average Established Patient Copayment $27.79
  • Minimum Established Patient Copayment $5.26
  • Maximum Established Patient Copayment $38.82

* 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.

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. Masaya Higuchi is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
MASSACHUSETTS GENERAL HOSPITAL55 FRUIT STREET
BOSTON, MA 02114
(617) 724-9725Acute Care Hospitals
MASSACHUSETTS EYE AND EAR INFIRMARY -243 CHARLES STREET
BOSTON, MA 02114
(617) 523-7900Acute Care Hospitals

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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.
1457544892
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
241071048818
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 4 + 1 + 0 + 7 + 1 + 0 + 4 + 8 + 8 + 1 + 8 + 24 = 68
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 68 = 22

The NPI number 1457544892 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 2 providers are registered at the same or nearby location.

MS. HALEY S REDSTONE NP

Nurse Practitioner

165 CAMBRIDGE ST STE 502
BOSTON, MA
ZIP 02114

(617) 726-4600

DEBORAH SULKI LEE

Internal Medicine

(Geriatric Medicine)

165 CAMBRIDGE ST STE 502
BOSTON, MA
ZIP 02114

(617) 726-4600

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1457544892, enumerated as an "individual" on August 20, 2007.

The provider is located at 165 CAMBRIDGE ST STE 502 BOSTON, MA 02114 and the phone number is (617) 726-4600.

Family Medicine with taxonomy code 207Q00000X.

The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield, Medicare and. Please consult your insurance carrier or call the provider to verify.

Masaya Higuchi is affiliated with: MASSACHUSETTS GENERAL HOSPITAL and MASSACHUSETTS EYE AND EAR INFIRMARY -.