JOHN T ELLENA MD
NPI 1487767240
Internal Medicine in Saint Louis, MO

NPI Status: Active since August 16, 2006

Contact Information

1040 N MASON RD STE 102
SAINT LOUIS, MO
ZIP 63141
Phone: (314) 758-6053

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  • Individual
  • Male
  • Years of Experience 41
  • Internal Medicine
  • PECOS Enrolled
  • Accepts Medicare Approved Payment

About JOHN ELLENA

John Ellena is an internist established in Saint Louis, Missouri and his medical specialization is Internal Medicine with more than 41 years of experience. He graduated from Southern Illinois University School Of Medicine in 1983. The healthcare provider is registered in the NPI registry with number 1487767240 assigned on August 2006. The practitioner's primary taxonomy code is 207R00000X with license number 36600 (MO). The provider is registered as an individual and his NPI record was last updated 3 years ago.

NPI
1487767240
Provider Name
JOHN T ELLENA MD
Gender
Male
Entity Type
Individual
Location Address
1040 N MASON RD STE 102 SAINT LOUIS, MO 63141
Location Phone
(314) 758-6053
Mailing Address
1040 N MASON RD STE 102 SAINT LOUIS, MO 63141
Mailing Phone
(314) 758-6053
Medical School Name
SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
Graduation Year
1983
Is Sole Proprietor?
No
Enumeration Date
08-16-2006
Last Update Date
10-25-2021
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An internist like John Ellena 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.

John Ellena 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 typical physician office visit costs for Medicare beneficiaries in this area are: $33.46 for a new patient copayment and $25.84 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

Taxonomy Code
207R00000X
Type
Allopathic & Osteopathic Physicians
License No.
36600
License State
MO
Taxonomy Description
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Insurance Plans Accepted

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

  • Aetna CVS Health

    • Bronze 2 HSA: Aetna network of doctors & hospitals + MinuteClinic + Virtual Care 24/7 - EPO
    • Bronze 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - EPO
    • Bronze S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - EPO
    • Gold 3: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - EPO
    • Gold S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - EPO
    • Silver 5: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - EPO
    • Silver 6: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - EPO
    • Silver 7: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - EPO
    • Silver S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - EPO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

PECOS Enrollment and Medicare Participation Status

John Ellena 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: 7618885898

    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: I20080206000439

    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

  • Other DME (D1E)

    Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (HCPCS:A4253)

    23 DME suppliers used 58 Medicare Claims 143 Services Paid

  • Other DME (D1E)

    Lancets, per box of 100 (HCPCS:A4259)

    13 DME suppliers used 22 Medicare Claims 35 Services Paid

  • Other DME (D1E)

    Nebulizer, with compressor (HCPCS:E0570)

    1 DME suppliers used 11 Medicare Claims 11 Services Paid

  • Oxygen and supplies (D1C)

    Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)

    3 DME suppliers used 14 Medicare Claims 19 Services Paid

  • Other DME (D1E)

    Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service (HCPCS:K0553)

    3 DME suppliers used 25 Medicare Claims 25 Services Paid

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 63141 ZIP code area.

New Patients Visit Costs *

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

  • Average New Patient Price $133.86
  • Minimum New Patient Price $58.16
  • Maximum New Patient Price $176.77
  • Average New Patient Copayment $33.46
  • Minimum New Patient Copayment $14.54
  • Maximum New Patient Copayment $44.19

Established Patients Visit Costs *

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

  • Average Established Patient Price $103.38
  • Minimum Established Patient Price $18.08
  • Maximum Established Patient Price $144.4
  • Average Established Patient Copayment $25.84
  • Minimum Established Patient Copayment $4.52
  • Maximum Established Patient Copayment $36.1

* 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.

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.

  • 380

    Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit (HCPCS:G0439)

  • 120

    Administration of influenza virus vaccine (HCPCS:G0008)

  • 118

    Vaccine for influenza for injection into muscle (HCPCS:90662)

  • 88

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

  • 46

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

  • 20

    Injection beneath the skin or into muscle for therapy, diagnosis, or prevention (HCPCS:96372)

  • 19

    Administration of pneumococcal vaccine (HCPCS:G0009)

  • 16

    Physician 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 to affirm the initial implem (HCPCS:G0180)

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. John Ellena is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
BARNES JEWISH HOSPITALONE BARNES-JEWISH HOSPITAL PLAZA
SAINT LOUIS, MO 63110
(314) 747-3000Acute Care Hospitals
MISSOURI BAPTIST MEDICAL CENTER3015 N BALLAS RD
TOWN AND COUNTRY, MO 63131
(314) 996-5000Acute Care Hospitals
BARNES-JEWISH WEST COUNTY HOSPITAL12634 OLIVE BOULEVARD
CREVE COEUR, MO 63141
(314) 996-8000Acute Care Hospitals
ST LUKES HOSPITAL232 S WOODS MILL RD
CHESTERFIELD, MO 63017
(314) 434-1500Acute Care Hospitals
PROGRESS WEST HOSPITAL2 PROGRESS POINT PKWY
O FALLON, MO 63368
(636) 344-1000Acute 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.
1487767240
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
241671461428
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 4 + 1 + 6 + 7 + 1 + 4 + 6 + 1 + 4 + 2 + 8 + 24 = 70
Step 3: because the number obtained in step 2 ends in zero, the check digit is zero.
0

The NPI number 1487767240 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1760522916DR. VINAY GOPAL KAMAT M.D.
Individual
Internal Medicine1040 N MASON RD STE 102
SAINT LOUIS, MO 63141
(314) 758-6053

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1487767240, enumerated in the NPI registry as an "individual" on August 16, 2006

The provider is located at 1040 N Mason Rd Ste 102 Saint Louis, Mo 63141 and the phone number is (314) 758-6053

The provider's speciality is Internal Medicine with taxonomy code 207R00000X

The provider has more than 41 years of experience. He graduated from Southern Illinois University School Of Medicine in 1983.

The provider might be accepting Accepts: Aetna CVS Health. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Yes, as of May 21, 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.

Medicare beneficiaries should expect a typical cost of $133.86 with an average copayment of $33.46 for new patient appointments. Established patients should expect a typical charge of $103.38 and an average copayment of 25.84. 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: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit, Administration of influenza virus vaccine, Vaccine for influenza for injection into muscle, Insertion of needle into vein for collection of blood sample, Routine ekg using at least 12 leads including interpretation and report, Injection beneath the skin or into muscle for therapy, diagnosis, or prevention, Administration of pneumococcal vaccine and Physician 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 to affirm the initial implem.

The practitioner is affiliated to the following hospital(s): BARNES JEWISH HOSPITAL, MISSOURI BAPTIST MEDICAL CENTER, BARNES-JEWISH WEST COUNTY HOSPITAL, ST LUKES HOSPITAL and PROGRESS WEST HOSPITAL. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

This NPI record was last updated on August 16, 2006. 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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