STEPHEN KAROL M.D.
NPI 1487709986
Physical Medicine & Rehabilitation in Merrillville, IN

Active since January 24, 2007PECOS EnrolledAccepts Medicare Assignment
70.04/100
CMS Quality Rating
521 E 86TH AVE, SUITE Z, MERRILLVILLE, IN 46410(219) 769-0777(219) 755-0612 Get Directions Write a Review

NPPES record last updated: October 12, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Stephen Karol M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STEPHEN KAROL M.D. (NPI 1487709986) is an individual physical medicine & rehabilitation provider in Merrillville, Indiana, licensed in Indiana (01050812) and active in the NPI registry since January 2007. He is enrolled in Medicare PECOS, is affiliated with St Mary Medical Center Inc, and is a graduate of Indiana University School Of Medicine (1996).

NPPES Registry Identity

NPI1487709986
Entity TypeIndividualMale
Primary Taxonomy208100000X
Provider Legal NameSTEPHEN KAROLCredential: M.D.
Location Address521 E 86TH AVE, SUITE ZMerrillville, IN 46410-6173
Mailing Address521 E 86th Ave, Suite ZMerrillville, IN 46410-6173 · (219) 769-0777 · Fax (219) 755-0612
Fax(219) 755-0612
Sole ProprietorNo
Medical School CMSIndiana University School Of MedicineGraduated 1996
Enumeration DateJanuary 24, 2007
Last NPPES UpdateOctober 12, 2012
NPI 1487709986 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysical Medicine & RehabilitationAllopathic & Osteopathic Physicians
Taxonomy Code208100000X
License Licensed in IN · 01050812
Definition
Physical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and treating patients with physical disabilities. These disabilities may arise from conditions affecting the musculoskeletal system such as neck and back pain, sports injuries, or other painful conditions affecting the limbs, such as carpal tunnel syndrome. Alternatively, the disabilities may result from neurological trauma or disease such as spinal cord injury, head injury or stroke. A physician certified in physical medicine and rehabilitation is often called a physiatrist. The primary goal of the physiatrist is to achieve maximal restoration of physical, psychological, social and vocational function through comprehensive rehabilitation. Pain management is often an important part of the role of the physiatrist. For diagnosis and evaluation, a physiatrist may include the techniques of electromyography to supplement the standard history, physical, x-ray and laboratory examinations. The physiatrist has expertise in the appropriate use of therapeutic exercise, prosthetics (artificial limbs), orthotics and mechanical and electrical devices.
521 E 86TH AVE, Merrillville, IN 46410

Other Identifiers 3

Other203952Anthem
Medicare ID-Type Unspecified497970N
Medicare UPINH21274

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Stephen Karol M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1658569751
PECOS Enrollment IDI20101215001119
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 8

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
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.
2,312 services326 patients
Hospital discharge day management, more than 30 minutes 99239
Hospital discharge day management over 30 minutes involves a detailed process to ensure a smooth transition from hospital to home. It includes final examinations, discussion of your hospital stay, post-discharge instructions, and coordinating follow-up care.
337 services306 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
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.
332 services305 patients
Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99231
Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.
66 services49 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
42 services38 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
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.
37 services28 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Mary Medical Center Inc

Acute Care Hospitals · Hobart, IN
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number150034
Location1500 S Lake Park AveHobart, IN 46342 · Lake County
Emergency services Birthing friendly

Community Hospital

Acute Care Hospitals · Munster, IN
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number150125
Location901 Macarthur BlvdMunster, IN 46321 · Lake County
Emergency services Birthing friendly

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

70.04/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality80.66
Improvement Activities40
Cost25.91

Reported Quality Measures

Care Plan
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker…
4%641 patients1/55-star benchmark: 100%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
94%65 patients4/55-star benchmark: 100%
Preventive Care and Screening: Screening for Depression and Follow-Up Plan
Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen
91%66 patients4/55-star benchmark: 100%
Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling
Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 24 months AND who received brief counseling if identified as an unhealthy alcohol user
98%55 patients4/55-star benchmark: 100%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 16

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Walker, folding, wheeled, adjustable or fixed height E0143
DME-Other DME · category DE000N
4 suppliers40 claims40 services$37.99 avg. paid by Medicare
Commode chair, mobile or stationary, with detachable arms E0165
DME-Other DME · category DE000N
2 suppliers34 claims35 services$9.08 avg. paid by Medicare
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress E0260
DME-Hospital Beds · category DB000N
3 suppliers32 claims32 services$37.72 avg. paid by Medicare
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431
DME-Oxygen and Supplies · category DC000N
4 suppliers39 claims39 services$15.79 avg. paid by Medicare
Nebulizer, with compressor E0570
DME-Other DME · category DE000N
2 suppliers18 claims18 services$4.10 avg. paid by Medicare
Manual wheelchair accessory, wheel lock brake extension (handle), each E0961
DME-Wheelchairs · category DD021N
2 suppliers11 claims22 services$18.13 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Counselor (Mental Health)
521 E 86TH AVE
MERRILLVILLE, IN 46410
Psychiatry & Neurology (Neurology with Special Qualifications in Child Neurology)
521 E 86TH AVE, SUITE Z
MERRILLVILLE, IN 46410
Counselor (Mental Health)
521 E 86TH AVE
MERRILLVILLE, IN 46410
Clinical Medical Laboratory
521 E 86TH AVE
MERRILLVILLE, IN 46410
Internal Medicine
521 E 86TH AVE, SUITE Z
MERRILLVILLE, IN 46410
Nurse Practitioner (Family)
521 E 86TH AVE
MERRILLVILLE, IN 46410
Orthopaedic Surgery
521 E 86TH AVE, SUITE P
MERRILLVILLE, IN 46410
Physical Therapist
521 E 86TH AVE, SUITE J
MERRILLVILLE, IN 46410

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Stephen Karol's NPI number?

The NPI number for Stephen Karol is 1487709986. It was assigned to this individual provider in the NPPES registry on January 24, 2007.

Where is Stephen Karol located?

Stephen Karol practices at 521 E 86th Ave Suite Z, Merrillville, IN 46410. The listed phone number is (219) 769-0777.

What is Stephen Karol's specialty?

The primary specialty registered for this NPI is Physical Medicine & Rehabilitation with taxonomy code 208100000X.

Is Stephen Karol enrolled in Medicare?

Yes. Stephen Karol is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Stephen Karol accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan and Ambetter from Meridian list Stephen Karol as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Stephen Karol affiliated with any hospitals?

According to CMS data, Stephen Karol is affiliated with St Mary Medical Center Inc and Community Hospital.

When was this NPI record last updated?

The NPPES record for Stephen Karol was last updated on October 12, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.