KARL D SHIVELY MD NPI 1497914295

Orthopaedic Surgery in Carmel, IN

Individual Male Years of Experience 19 Orthopaedic Surgery PECOS Enrolled Accepts Medicare Approved Payment

About KARL D SHIVELY MD

Karl Shively is a provider established in Carmel, Indiana and his medical specialization is Orthopaedic Surgery with more than 19 years of experience. He graduated from University Of Illinois College Of Med (chi/peor/rock/chm-urb) in 2004. The NPI number of Karl Shively is 1497914295 and was assigned on June 2008. The practitioner's primary taxonomy code is 207X00000X with license number 01068208A (IN). The provider is registered as an individual and his NPI record was last updated 2 years ago.

NPI

1497914295

Provider Name KARL D SHIVELY MD
Provider Location Address11725 ILLINOIS ST STE 520 CARMEL, IN 46032
Provider Mailing Address720 ESKENAZI AVE INDIANAPOLIS, IN 46202
GenderMale
NPI Entity TypeIndividual
Medical School NameUNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduation Year2004
Is Sole Proprietor?No
Enumeration Date06-05-2008
Last Update Date12-30-2020



Karl Shively 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.

Karl Shively is registered with Medicare and accepts claims assignment, this means the provider accepts Medicare's approved amount for the cost of rendered services as full payment. Participating providers may not charge Medicare beneficiaries more than Medicare's approved amount for their services. Medicare beneficiaries still have to pay a coinsurance or copayment amount for a visit or service. According to Medicare claims data he has hospital affiliations with Eskenazi Health and Indiana University Health North Hospital.

The typical physician office visit costs for Medicare beneficiaries in this area are: $21.13 for a new patient copayment and $17.24 for an established patient copayment.



Primary Taxonomy

Taxonomy Code207X00000X
ClassificationOrthopaedic Surgery
TypeAllopathic & Osteopathic Physicians
License No.01068208A
License StateIN
Taxonomy DescriptionAn orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.

Business Address

KARL D SHIVELY MD
11725 ILLINOIS ST STE 520
CARMEL, IN
ZIP 46032
Phone: (317) 630-7889
Fax: (317) 968-1098

Get Directions


Mailing Address

KARL D SHIVELY MD
720 ESKENAZI AVE
INDIANAPOLIS, IN
ZIP 46202
Phone: (317) 880-3607


PECOS Enrollment and Medicare Participation

What is PECOS?
PECOS is the Medicare Provider, Enrollment, Chain and Ownership System. PECOS is Medicare's enrollment and revalidation system and it is the primary source of information about verified Medicare professionals. A NPI number is necessary to register in PECOS. Providers must enroll in PECOS to avoid denied claims.

Registered in PECOS? Yes
PECOS PAC ID7719001239
PECOS Enrollment IDI20100903000615
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 order / refer Part B Clinical Laboratory and ImagingYes
Eligible order / refer Durable Medical EquipmentYes
Eligible order / refer Home Health Agency (HHA)Yes
Eligible order / refer Power Mobility DevicesYes

Physician Office Visit Costs

The provider accepts as payment the Medicare approved amount. Medicare beneficiaries should not be billed for more than the Medicare deductible and coinsurance amounts. Medicare pricing is usually a reference point for private insurance covered patients. The prices below reflect the costs for new and established patients in the 46032 ZIP code area.

New Patients Office Visits Costs *
Most Utilized Procedure Code for new patients office visits: 99203
Minimum New Patient Pricing Maximum New Patient Pricing Typical New Patient Pricing
$54.76 $167.54 $84.54
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$13.69 $41.88 $21.13
Established Patients Office Visits Costs *
Most Utilized Procedure Code for established patients office visits: 99213
Minimum Established Patient Pricing Maximum Established Patient Pricing Typical Established Patient Pricing
$16.96 $137.16 $68.99
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$4.24 $34.29 $17.24

* The physician office visit costs information is obtained by Medicare's statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Clinician Utilization

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 2017. The reported codes are based on the top 5 codes for each available Medicare specialty, excluding evaluation and management codes.

  • 38Aspiration and/or injection of large joint or joint capsule (HCPCS:20610)

Hospital Affiliations

Medicare hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the Medicare 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. Karl Shively is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
ESKENAZI HEALTH720 ESKENAZI AVENUE
INDIANAPOLIS, IN 46202
(317) 880-4818Acute Care Hospitals150024
INDIANA UNIVERSITY HEALTH NORTH HOSPITAL11700 N MERIDIAN ST
CARMEL, IN 46032
(317) 688-2000Acute Care Hospitals150161

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
200990360MEDICAID (05)IN
P01052538OTHER (01)INRAILROAD MEDICARE

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.
1497914295
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
241871818218
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 4 + 1 + 8 + 7 + 1 + 8 + 1 + 8 + 2 + 1 + 8 + 24 = 75
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
80 - 75 = 55

The NPI number 1497914295 is valid because the calculated check digit 5 using the Luhn validation algorithm matches the last digit of the original NPI number.

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
Karl D Shively Md is registered as an entity type code: 1. The entity type code describes the type of health care provider that is being assigned an NPI. The entity type codes are:

  • 1 = Person: individual human being who furnishes health care.
  • 2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.