SARAH M. MACIAS P.T. NPI 1518073493

Physical Therapist in Rockford, IL

NPI 1518073493 Individual Female Years of Experience 18 Physical Therapist Accepts Medicare Approved Payment MIPS Quality Score 72.2

About SARAH MACIAS

Sarah Macias is a provider established in Rockford, Illinois and her medical specialization is physical therapist with more than 18 years of experience. The NPI number of Sarah Macias is 1518073493 and was assigned on August 2006. The practitioner's primary taxonomy code is 225100000X with license number 070-014118 (IL). The provider is registered as an individual and her NPI record was last updated 7 years ago. Sarah Macias 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.

The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 72.2, 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: $33.02 for a new patient copayment and $17.85 for an established patient copayment.

NPI

1518073493

Provider Name SARAH M. MACIAS P.T.
Provider Location Address324 ROXBURY RD ROCKFORD, IL 61107
Provider Mailing AddressBOX 78534 MILWAUKEE, WI 53278
GenderFemale
NPI Entity TypeIndividual
Medical School NameOTHER
Graduation Year2004
Is Sole Proprietor?No
Is Organization Subpart?N/A
Enumeration Date08-22-2006
Last Update Date12-11-2014


Primary Taxonomy

Taxonomy Code225100000X
ClassificationPhysical Therapist
TypeRespiratory, Developmental, Rehabilitative and Restorative Service Providers
License No.070-014118
License StateIL
Taxonomy DescriptionPhysical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles. PTs:
  • Diagnose and manage movement dysfunction and enhance physical and functional abilities.
  • Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.
  • Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.
  • Treat conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems.
  • Address the negative effects attributable to unique personal and environmental factors as they relate to human performance.
PTs provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a PT practices.

Business Address

SARAH M. MACIAS P.T.
324 ROXBURY RD
ROCKFORD, IL
ZIP 61107
Phone: (815) 381-7431
Fax: (815) 381-7498

Get Directions


Mailing Address

SARAH M. MACIAS P.T.
BOX 78534
MILWAUKEE, WI
ZIP 53278
Phone: (815) 381-7431
Fax: (815) 381-7498



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.

PECOS PAC ID7618930785
PECOS Enrollment IDI20041109001077
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.

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 61107 ZIP code area.

New Patients Office Visits Costs *
Most Utilized Procedure Code for new patients office visits: 99204
Minimum New Patient Pricing Maximum New Patient Pricing Typical New Patient Pricing
$56.93 $174.63 $132.1
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$14.23 $43.65 $33.02
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
$17.32 $142.11 $71.4
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$4.33 $35.52 $17.85

* 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.

Overall MIPS Quality Performance

The Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in Medicare's 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.

MIPS Measure Score Weight Score
Quality 40% N/A
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 (PI) 25% 61
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 15% 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 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 20% 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.
MIPS Final Score - 72.2
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.

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.

  • 852Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes (HCPCS:97110)
  • 248Manual (physical) therapy techniques to 1 or more regions, each 15 minutes (HCPCS:97140)
  • 55Physical therapy evaluation (HCPCS:97001)
  • 41Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes (HCPCS:97112)

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
K12060MEDICARE PIN (08)IL

Other Providers at the same location


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

NPI Name / Type Taxonomy Address
1841303377 NORMAN A HAGMAN M.D.
Individual
Orthopaedic Surgery324 ROXBURY RD
ROCKFORD, IL 61107
(815) 398-9491
1750497905 CAROL BITNER P.T.
Individual
Physical Therapist324 ROXBURY RD
ROCKFORD, IL 61107
(815) 398-9491
1316053291 AMY C. NAGEL P.T.
Individual
Physical Therapist324 ROXBURY RD
ROCKFORD, IL 61107
(815) 398-9491
1881701365 CONRAD C. LO P.A.-C.
Individual
Physician Assistant324 ROXBURY RD
ROCKFORD, IL 61107
(815) 398-9491
1255440871MRS. MAUREEN ELIZABETH NICOLLS MSPT
Individual
Physical Therapist324 ROXBURY RD
ROCKFORD, IL 61107
(815) 398-9491
1952403347 COLLEEN M. FERGUSON O.T.
Individual
Occupational Therapist324 ROXBURY RD
ROCKFORD, IL 61107
(815) 398-9491
1063633048 TANYA C. LIBBY P.T.
Individual
Physical Therapist324 ROXBURY RD
ROCKFORD, IL 61107
(815) 398-9491
1952571796 MICHAEL R BRUEMMER PTA
Individual
Physical Therapy Assistant324 ROXBURY RD
ROCKFORD, IL 61107
(815) 398-9491
1083857924 CINDY L FEARN A.P.N.
Individual
Clinical Nurse Specialist (Occupational Health)324 ROXBURY RD
ROCKFORD, IL 61107
(815) 398-9491
1669601852MR. MARK ROBERT ROBINSON ATC, CSCS
Individual
Specialist/Technologist (Athletic Trainer)324 ROXBURY RD
ROCKFORD, IL 61107
(815) 398-9491
1801109301MR. JOHN T BRINKMANN CPO, LPO, FAAOP
Individual
Prosthetist324 ROXBURY RD
ROCKFORD, IL 61107
(815) 398-9491
1063472751 JIMMY L WALKER JR. PA-C
Individual
Physician Assistant (Surgical)324 ROXBURY RD
ROCKFORD, IL 61107
(815) 381-7431
1760776884DR. AMIE LEHMAN HARACZ D.P.M.
Individual
Podiatrist (Foot & Ankle Surgery)324 ROXBURY RD
ROCKFORD, IL 61107
(815) 381-7339
1053696971 CARLY ANNE JACKSON PA-C
Individual
Physician Assistant324 ROXBURY RD
ROCKFORD, IL 61107
(815) 398-9491
1730136474ROCKFORD ORTHOPEDIC ASSOCIATES, LTD.
Organization
Orthopaedic Surgery324 ROXBURY RD
ROCKFORD, IL 61107
(815) 398-9491
1740396647 KATHLEEN A. LARSON O.T.
Individual
Occupational Therapist324 ROXBURY RD
ROCKFORD, IL 61107
(815) 381-7431
1427164359 JENNIFER E. BETO O.T.
Individual
Occupational Therapist324 ROXBURY RD
ROCKFORD, IL 61107
(815) 381-7431
1043506082 BRYCE T ALDERKS DPT
Individual
Physical Therapist324 ROXBURY RD
ROCKFORD, IL 61107
(815) 381-7431
1639414956 ANDREW FLEMING PT
Individual
Physical Therapist324 ROXBURY RD
ROCKFORD, IL 61107
(815) 381-7431
1144649435 JENNIFER A PETERSEN O.T.R.
Individual
Occupational Therapist324 ROXBURY RD
ROCKFORD, IL 61107
(815) 381-7431

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
The code describing 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.