DR. TODD MICHAEL JAMES D.O.
NPI 1467764498
Internal Medicine - Cardiovascular Disease in Grand Jct, CO


Quality Rating: 98.44 out of 100 score

NPI Status: Active since July 07, 2010

Contact Information

2373 G RD STE 280
GRAND JCT, CO
ZIP 81505
Phone: (970) 644-4030
Fax: (970) 644-3914

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  • Individual
  • Male
  • Years of Experience 15
  • Internal Medicine
  • Cardiovascular Disease
  • PECOS Enrolled
  • Accepts Medicare Approved Payment

About TODD JAMES

Todd James is an internist established in Grand Jct, Colorado and his medical specialization is Internal Medicine with a focus in cardiovascular disease with more than 15 years of experience. The healthcare provider is registered in the NPI registry with number 1467764498 assigned on July 2010. The practitioner's primary taxonomy code is 207RC0000X with license number DR.0065812 (CO). The provider is registered as an individual and his NPI record was last updated 3 years ago.

NPI
1467764498
Provider Name
DR. TODD MICHAEL JAMES D.O.
Gender
Male
Entity Type
Individual
Location Address
2373 G RD STE 280 GRAND JCT, CO 81505
Location Phone
(970) 644-4030
Location Fax
(970) 644-3914
Mailing Address
PO BOX 1727 GRAND JCT, CO 81502
Mailing Phone
(970) 644-4030
Mailing Fax
(970) 644-3914
Medical School Name
OTHER
Graduation Year
2010
Is Sole Proprietor?
Yes
Enumeration Date
07-07-2010
Last Update Date
04-01-2021
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An internist like Todd James is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.

Todd James 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 98.44, 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: $34.3 for a new patient copayment and $26.58 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

Internal Medicine Cardiovascular Disease

Taxonomy Code
207RC0000X
Type
Allopathic & Osteopathic Physicians
License No.
DR.0065812
License State
CO
Taxonomy Description
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

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)
1207RC0000XAllopathic & Osteopathic Physicians

Internal Medicine
Cardiovascular Disease

7205 (AZ)

Insurance Plans Accepted

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

  • Blue Cross and Blue Shield of Nebraska

    • HeartlandBlue Bronze HSA 6500 NEtwork Blue - EPO
  • Imperial Insurance Companies, Inc.

    • Imperial Preferred Gold - HMO
    • Imperial Preferred Silver - HMO
    • Imperial Standard Bronze - HMO
    • Imperial Standard Gold - HMO
    • Imperial Standard Silver - HMO
  • Medica

    • Essentia Choice Care with Medica Bronze Copay $0 PCP - HMO
    • Essentia Choice Care with Medica Bronze Share Plus - HMO
    • Essentia Choice Care with Medica Bronze Standard - HMO
    • Essentia Choice Care with Medica Catastrophic - HMO
    • Essentia Choice Care with Medica Expanded Bronze Standard - HMO
    • Essentia Choice Care with Medica Gold Copay $0 PCP - HMO
    • Essentia Choice Care with Medica Gold Standard - HMO
    • Essentia Choice Care with Medica Silver Copay $0 PCP - HMO
    • Essentia Choice Care with Medica Silver Standard - HMO
    • Medica Individual Choice Bronze Copay - EPO
  • Oscar Insurance Company

    • Bronze Classic - EPO
    • Bronze Classic 4700 - EPO
    • Bronze Classic PCP Saver - EPO
    • Bronze Classic Standard - EPO
    • Bronze Elite + PCP Saver Plus - EPO
    • Gold Classic Standard - EPO
    • Gold Elite - EPO
    • Secure - EPO
    • Silver Classic - EPO
    • Silver Classic Standard - EPO
  • Priority Health

    • MyPriority Balanced Silver - HMO
    • MyPriority Premier Silver - HMO
    • MyPriority Standard Bronze - HMO
    • MyPriority Standard Bronze - Travel - HMO
    • MyPriority Standard Gold - HMO
    • MyPriority Standard Silver - HMO
    • MyPriority Standard Silver - Travel - HMO
    • MyPriority Value Bronze - HMO
    • MyPriority Value Bronze HSA - HMO
  • 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
Z204014OTHER (01)AZMEDICARE
279139MEDICAID (05)AZ 

PECOS Enrollment and Medicare Participation Status

Todd James 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: 3476700105

    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: I20230913003509, I20240307000989

    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 81505 ZIP code area.

New Patients Visit Costs *

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

  • Average New Patient Price $137.2
  • Minimum New Patient Price $60.06
  • Maximum New Patient Price $181
  • Average New Patient Copayment $34.3
  • Minimum New Patient Copayment $15.01
  • Maximum New Patient Copayment $45.25

Established Patients Visit Costs *

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

  • Average Established Patient Price $106.32
  • Minimum Established Patient Price $18.98
  • Maximum Established Patient Price $148.2
  • Average Established Patient Copayment $26.58
  • Minimum Established Patient Copayment $4.74
  • Maximum Established Patient Copayment $37.05

* 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: 98.44 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: 98.16

    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: N/A

    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.

  • 238

    Routine ekg using at least 12 leads including interpretation and report (HCPCS:93000)

  • 151

    Insertion of needle into vein for collection of blood sample (HCPCS:36415)

  • 104

    Blood test, comprehensive group of blood chemicals (HCPCS:80053)

  • 52

    Remote evaluations of single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report, up to 90 days (HCPCS:93294)

  • 52

    Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes (HCPCS:99152)

  • 32

    Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function (HCPCS:93306)

  • 32

    Complete blood cell count (red cells, white blood cell, platelets), automated test (HCPCS:85025)

  • 31

    Ultrasound guidance for accessing into blood vessel (HCPCS:76937)

  • 26

    Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart (HCPCS:93458)

  • 19

    Nuclear medicine study of vessels of heart using drugs or exercise multiple studies (HCPCS:78452)

  • 18

    Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician analysis, review, and report (HCPCS:93280)

Hospital Affiliations

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. Todd James is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
MCLAREN NORTHERN MICHIGAN416 CONNABLE AVE
PETOSKEY, MI 49770
(231) 487-4000Acute Care Hospitals
ESSENTIA HEALTH ST JOSEPH'S MEDICAL CENTER523 NORTH 3RD STREET
BRAINERD, MN 56401
(218) 829-2861Acute 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.
1467764498
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
241271468418
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 4 + 1 + 2 + 7 + 1 + 4 + 6 + 8 + 4 + 1 + 8 + 24 = 72
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
80 - 72 = 88

The NPI number 1467764498 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 7 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1154361046DR. BRADLEY ALAN BALDWIN DO
Individual
Surgery2373 G RD STE 280 SURGICAL ASSOCIATES
GRAND JUNCTION, CO 81505
(970) 243-9340
1588027247 RYAN O'DELL D.O.
Individual
Surgery2373 G RD STE 280
GRAND JCT, CO 81505
(970) 243-9343
1902179146 DAVID J LUNDY MD
Individual
Surgery2373 G RD STE 280
GRAND JCT, CO 81505
(970) 243-9340
1437634094 GABRIEL DELEON PA
Individual
Physician Assistant (Surgical)2373 G RD STE 280
GRAND JUNCTION, CO 81505
(970) 243-9340
1891411534COMMUNITY SPECIALTY GROUP LLC
Organization
Specialist2373 G RD STE 280
GRAND JUNCTION, CO 81505
(970) 243-9340
1881362184 NAOMI A MARTIN
Individual
Physician Assistant2373 G RD STE 280
GRAND JUNCTION, CO 81505
(970) 243-9340
1164997524COMMUNITY MEDICAL GROUP, LLC
Organization
Surgery2373 G RD STE 280
GRAND JUNCTION, CO 81505
(970) 243-9340

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1467764498, enumerated in the NPI registry as an "individual" on July 07, 2010

The provider is located at 2373 G Rd Ste 280 Grand Jct, Co 81505 and the phone number is (970) 644-4030

The provider's speciality is Internal Medicine with taxonomy code 207RC0000X with a focus in Cardiovascular Disease

The provider has more than 15 years of experience.

The provider might be accepting Accepts: Blue Cross and Blue Shield of Nebraska, Imperial. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Yes, as of July 02, 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.

Medicare beneficiaries should expect a typical cost of $137.2 with an average copayment of $34.3 for new patient appointments. Established patients should expect a typical charge of $106.32 and an average copayment of 26.58. 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: Routine ekg using at least 12 leads including interpretation and report, Insertion of needle into vein for collection of blood sample, Blood test, comprehensive group of blood chemicals, Remote evaluations of single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report, up to 90 days, Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes, Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function, Complete blood cell count (red cells, white blood cell, platelets), automated test, Ultrasound guidance for accessing into blood vessel, Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart, Nuclear medicine study of vessels of heart using drugs or exercise multiple studies and Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician analysis, review, and report.

The practitioner is affiliated to the following hospital(s): MCLAREN NORTHERN MICHIGAN and ESSENTIA HEALTH ST JOSEPH'S MEDICAL CENTER. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

This NPI record was last updated on July 07, 2010. 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].
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