DIANE R MERRILL NP
NPI 1487767406
Nurse Practitioner in Concord, NC


Quality Rating: 98.39 out of 100 score

NPI Status: Active since August 16, 2006

Contact Information

1090 NE GATEWAY CT NE
STE 201
CONCORD, NC
ZIP 28025
Phone: (704) 403-7770

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  • Individual
  • Female
  • Years of Experience 26
  • Nurse Practitioner
  • PECOS Enrolled
  • Accepts Medicare Approved Payment

About DIANE MERRILL

Diane Merrill is a provider established in Concord, North Carolina and her medical specialization is Nurse Practitioner with more than 26 years of experience. The healthcare provider is registered in the NPI registry with number 1487767406 assigned on August 2006. The practitioner's primary taxonomy code is 363L00000X with license number 960021 (NC). The provider is registered as an individual and her NPI record was last updated one year ago.

NPI
1487767406
Provider Name
DIANE R MERRILL NP
Gender
Female
Entity Type
Individual
Location Address
1090 NE GATEWAY CT NE STE 201 CONCORD, NC 28025
Location Phone
(704) 403-7770
Mailing Address
PO BOX 19305 CHARLOTTE, NC 28219
Medical School Name
OTHER
Graduation Year
1998
Is Sole Proprietor?
No
Enumeration Date
08-16-2006
Last Update Date
12-18-2023
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A nurse practitioner (NP) like Diane Merrill is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.

Diane Merrill 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 98.39, 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: $21.8 for a new patient copayment and $25.2 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

Nurse Practitioner

Taxonomy Code
363L00000X
Type
Physician Assistants & Advanced Practice Nursing Providers
License No.
960021
License State
NC
Taxonomy Description
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Location Map

Secondary Locations

  • 200 Medical Park Dr Ste 230
    Concord, NC 28025
    (704) 403-1349
  • 100 Medical Park Dr Ste 210
    Concord, NC 28025
    (704) 403-6100
  • 920 Church St N
    Concord, NC 28025
    (704) 403-1311

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

    • Ambetter Virtual Access Bronze (Virtual PCP selection required) - HMO
    • Ambetter Virtual Access Silver (Virtual PCP selection required) - HMO
    • Clear Silver - HMO
    • Clear Silver + Vision + Adult Dental - HMO
    • Complete Gold - HMO
    • Complete Gold + Vision + Adult Dental - HMO
    • Elite Bronze - HMO
    • Elite Bronze + Vision + Adult Dental - HMO
    • Elite Gold - HMO
    • Elite Gold + Vision + Adult Dental - HMO
  • Ambetter from Peach State Health Plan

    • Choice Bronze HSA - HMO
    • Choice Bronze HSA + Vision + Adult Dental - HMO
    • Clear Bronze - HMO
    • Clear Bronze + Vision + Adult Dental - HMO
    • Clear Gold - HMO
    • Clear Gold + Vision + Adult Dental - HMO
    • Clear Silver - HMO
    • Clear Silver + Vision + Adult Dental - HMO
    • Complete Gold - HMO
    • Complete Gold + Vision + Adult Dental - HMO
  • Ambetter of North Carolina

    • Ambetter Virtual Access Bronze (Virtual PCP selection required) - HMO
    • Ambetter Virtual Access Gold (Virtual PCP selection required) - HMO
    • Ambetter Virtual Access Silver (Virtual PCP selection required) - HMO
    • Choice Bronze HSA - HMO
    • Choice Bronze HSA + Vision + Adult Dental - HMO
    • Choice Bronze HSA with Atrium Health - HMO
    • Choice Bronze HSA with Atrium Health + Vision + Adult Dental - HMO
    • Clear Silver - HMO
    • Clear Silver + Vision + Adult Dental - HMO
    • Clear Silver with Atrium Health - HMO
  • Ambetter of Tennessee

    • Choice Bronze HSA - EPO
    • Choice Bronze HSA + Vision + Adult Dental - EPO
    • Clear Silver - EPO
    • Clear Silver + Vision + Adult Dental - EPO
    • Complete Gold - EPO
    • Complete Gold + Vision + Adult Dental - EPO
    • Complete Silver - EPO
    • Complete Silver + Vision + Adult Dental - EPO
    • Elite Bronze - EPO
    • Elite Bronze + Vision + Adult Dental - EPO
  • Blue Cross and Blue Shield of NC

    • Blue Advantage Bronze | $60 PCP | $20 Tier 1 Rx | Nationwide Doctors - PPO
    • Blue Advantage Bronze | 3 Free PCP | $20 Tier 1 Rx | Integrated | Nationwide Doctors - PPO
    • Blue Advantage Bronze | HSA Eligible | Integrated | Nationwide Doctors - PPO
    • Blue Advantage Bronze Standard | Nationwide Doctors - PPO
    • Blue Advantage Catastrophic | 3 PCP $35 | Integrated | Nationwide Doctors - PPO
    • Blue Advantage Gold | 3 Free PCP | $10 Tier 1 Rx | Nationwide Doctors - PPO
    • Blue Advantage Gold Standard | Nationwide Doctors - PPO
    • Blue Advantage Silver Choice | 3 Free PCP | $15 Tier 1 Rx | Nationwide Doctors - PPO
    • Blue Advantage Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | Nationwide Doctors - PPO
    • Blue Advantage Silver Secure | $15 PCP | $15 Tier 1 Rx | Nationwide Doctors - PPO
  • UnitedHealthcare

    • UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - HMO
    • UHC Bronze Essential ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - HMO
    • UHC Bronze Standard (No Referrals) - HMO
    • UHC Bronze Value ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, No Referrals) - HMO
    • UHC Bronze Value HSA (No Referrals) - HMO
    • UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) - HMO
    • UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) - HMO
    • UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, No Referrals) - HMO
    • UHC Gold Standard (No Referrals) - HMO
    • UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, $0 Insulin, No Referrals) - HMO
  • WellCare of North Carolina

    • Standard Expanded Bronze WellCare - PPO
    • Standard Gold WellCare - PPO
    • Standard Silver WellCare - PPO
    • WellCare Secure Health Bronze - PPO
    • WellCare Secure Health Gold - PPO
    • WellCare Secure Health Silver - PPO

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

PECOS Enrollment and Medicare Participation Status

Diane Merrill 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: 5395725907

    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: I20040723000610

    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 28025 ZIP code area.

New Patients Visit Costs *

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

  • Average New Patient Price $87.2
  • Minimum New Patient Price $56.51
  • Maximum New Patient Price $172.65
  • Average New Patient Copayment $21.8
  • Minimum New Patient Copayment $14.12
  • Maximum New Patient Copayment $43.16

Established Patients Visit Costs *

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

  • Average Established Patient Price $100.83
  • Minimum Established Patient Price $17.43
  • Maximum Established Patient Price $140.98
  • Average Established Patient Copayment $25.2
  • Minimum Established Patient Copayment $4.35
  • Maximum Established Patient Copayment $35.24

* 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: 98.39 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: 96.78

    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: 100

    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.

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. Diane Merrill is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
CAROLINAS MEDICAL CENTER-NORTHEAST920 CHURCH ST N
CONCORD, NC 28025
(704) 783-3000Acute Care Hospitals
CAROLINAS MEDICAL CENTER/BEHAV HEALTH1000 BLYTHE BLVD
CHARLOTTE, NC 28203
(704) 355-2000Acute 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.
1487767406
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
241671461440
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 + 4 + 0 + 24 = 64
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 64 = 66

The NPI number 1487767406 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1437493459 JENNIFER A BENT PT
Individual
Physical Therapist1090 NE GATEWAY CT NE SUITE 204A
CONCORD, NC 28025
(704) 403-9239
1598070369 JULIA M ROSKAMP M.A, FAAA
Individual
Audiologist-Hearing Aid Fitter1090 NE GATEWAY CT NE SUITE 101
CONCORD, NC 28025
(704) 403-9100
1043406036DR. KRISTINE VERA WADE AU.D
Individual
Audiologist-Hearing Aid Fitter1090 NE GATEWAY CT NE SUITE 101
CONCORD, NC 28025
(704) 403-9100
1487063962MRS. SARAH CLARE TORTORICI M.S., CCC-SLP
Individual
Speech-Language Pathologist1090 NE GATEWAY CT NE SUITE 101
CONCORD, NC 28025
(704) 403-9100
1578075743 ALEXANDRA NICOLE SOLTIS AU.D.
Individual
Audiologist1090 NE GATEWAY CT NE
CONCORD, NC 28025
(704) 403-9100
1427338995 ERIKA STEELE PA
Individual
Physician Assistant1090 NE GATEWAY CT NE SUITE 202
CONCORD, NC 28025
(704) 403-9050
1568488229 PATRICIA KALDY MD
Individual
Family Medicine1090 NE GATEWAY CT NE STE 202
CONCORD, NC 28025
(704) 403-9050
1417157611 STACY HENRICKSON NP
Individual
Nurse Practitioner1090 NE GATEWAY CT NE STE 204
CONCORD, NC 28025
(704) 403-7020
1003269606 LORI LOVETT ROBINSON FNP
Individual
Nurse Practitioner1090 NE GATEWAY CT NE STE 202
CONCORD, NC 28025
(704) 403-9050
1053337840 PAUL BREZICKI MD
Individual
Family Medicine1090 NE GATEWAY CT NE STE 202
CONCORD, NC 28025
(704) 403-9050
1629432281THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Organization
Orthopaedic Surgery1090 NE GATEWAY CT NE STE 204
CONCORD, NC 28025
(704) 403-7020
1750718243THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Organization
Internal Medicine (Pulmonary Disease)1090 NE GATEWAY CT NE STE 201
CONCORD, NC 28025
(704) 403-7770
1902049190CAROLINAS PHYSICIANS NETWORK INC
Organization
Family Medicine1090 NE GATEWAY CT NE STE 202
CONCORD, NC 28025
(704) 403-9050
1063474419 PATRICK THOMAS KELLY MD
Individual
Internal Medicine (Pulmonary Disease)1090 NE GATEWAY CT NE STE 201
CONCORD, NC 28025
(704) 403-7770
1073977948 SHANE CASEY TIPTON MD
Individual
Orthopaedic Surgery1090 NE GATEWAY CT NE STE 204
CONCORD, NC 28025
(704) 403-7020
1194471748 JAIMIE LEIGH MANKILLER FNP
Individual
Nurse Practitioner (Family)1090 NE GATEWAY CT NE STE 202
CONCORD, NC 28025
(704) 403-9050
1245395185 ANDREW GILLETT FERRIS DO
Individual
Orthopaedic Surgery1090 NE GATEWAY CT NE STE 204
CONCORD, NC 28025
(704) 403-7020
1780240077 EMILY MEAGAN WOODY PA
Individual
Physician Assistant1090 NE GATEWAY CT NE STE 202
CONCORD, NC 28025
(704) 403-9050
1053817619 JESSICA ANN PEOPLES PA
Individual
Physician Assistant1090 NE GATEWAY CT NE STE 202
CONCORD, NC 28025
(704) 403-9050
1073252532 ROBERT LEWIS SCHWARTZ PA
Individual
Physician Assistant1090 NE GATEWAY CT NE STE 204
CONCORD, NC 28025
(704) 403-7020

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1487767406, enumerated in the NPI registry as an "individual" on August 16, 2006

The provider is located at 1090 Ne Gateway Ct Ne Ste 201 Concord, Nc 28025 and the phone number is (704) 403-7770

The provider's speciality is Nurse Practitioner with taxonomy code 363L00000X

The provider has more than 26 years of experience.

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

Yes, as of June 14, 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 , uses technology to exchange and make use of healthcare information.

Medicare beneficiaries should expect a typical cost of $87.2 with an average copayment of $21.8 for new patient appointments. Established patients should expect a typical charge of $100.83 and an average copayment of 25.2. Please review your insurance plan or contact the provider directly to determine your specific costs.

The practitioner is affiliated to the following hospital(s): CAROLINAS MEDICAL CENTER-NORTHEAST and CAROLINAS MEDICAL CENTER/BEHAV HEALTH. 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].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.