BLAISE A NEMETH MD
NPI 1528027166
Orthopaedic Surgery - Pediatric Orthopaedic Surgery in Madison, WI
NPI Status: Active since March 22, 2006
Contact Information
5249 E TERRACE DR
MADISON, WI
ZIP 53718
Phone: (608) 265-1295
Fax: (608) 265-0933
- Individual
- Male
- Years of Experience 29
- Orthopaedic Surgery
- Pediatric Orthopaedic Surgery
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
About BLAISE NEMETH
This page provides the complete NPI Profile along with additional information for Blaise Nemeth, a provider established in Madison, Wisconsin with a medical specialization in Orthopaedic Surgery, focusing in pediatric orthopaedic surgery and more than 29 years of experience. He graduated from Washington University School Of Medicine in 1997. The healthcare provider is registered in the NPI registry with number 1528027166 assigned on March 2006. The practitioner's primary taxonomy code is 207XP3100X with license number 40299 (WI). The provider is registered as an individual and his NPI record was last updated 5 years ago.
- NPI
- 1528027166
- Provider Name
- BLAISE A NEMETH MD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 5249 E TERRACE DR MADISON, WI 53718
- Location Phone
- (608) 265-1295
- Location Fax
- (608) 265-0933
- Mailing Address
- 7974 UW HEALTH CT MIDDLETON, WI 53562
- Medical School Name
- WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
- Graduation Year
- 1997
- Is Sole Proprietor?
- No
- Enumeration Date
- 03-22-2006
- Last Update Date
- 09-14-2021
- Code Navigator
Location Map
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
Orthopaedic Surgery Pediatric Orthopaedic Surgery
- Taxonomy Code
- 207XP3100X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 40299
- License State
- WI
- Taxonomy Description
- An orthopedic surgeon who has additional training and experience in diagnosing, treating and managing musculoskeletal problems in infants, children and adolescents. These may include limb and spine deformities (such as club foot, scoliosis); gait abnormalities (limping); bone and joint infections; broken bones.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | 40299 (WI) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Anthem Bronze Pathway/Lean 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - HMO
- Anthem Bronze Pathway/Lean HSA (+ Incentives) - HMO
- Anthem Bronze Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Anthem Bronze Preferred/Broad 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - POS
- Anthem Bronze Preferred/Broad HSA (+ Incentives) - POS
- Anthem Bronze Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Gold Pathway/Lean 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Anthem Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Anthem Gold Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Gold Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- HMO Bronze $0 Medical Deductible - HMO
- HMO Bronze 10000 - HMO
- HMO Bronze 7500 - HMO
- HMO Catastrophic 10600 with 3 free PCP visits - HMO
- HMO Gold 2000 - HMO
- HMO Gold 2700 - HMO
- HMO HDHP Silver 5900 - HMO
- HMO Silver 6000 - HMO
- HMO Silver 6600 - HMO
- POS Bronze 7500 - POS
- CareSource (Common Ground Healthcare) Bronze $0 Ded / $2500 Rx Ded - EPO
- CareSource (Common Ground Healthcare) Bronze $0 Ded / $2500 Rx Ded - Vision Exam - EPO
- CareSource (Common Ground Healthcare) Bronze $9600 ($45 PCP Copay) - EPO
- CareSource (Common Ground Healthcare) Bronze $9600 ($45 PCP Copay) - Vision Exam - EPO
- CareSource (Common Ground Healthcare) Bronze Standard $7500 - EPO
- CareSource (Common Ground Healthcare) Bronze Standard $7500 - Vision Exam - EPO
- CareSource (Common Ground Healthcare) Gold $0 Ded - EPO
- CareSource (Common Ground Healthcare) Gold $0 Ded - Vision Exam - EPO
- CareSource (Common Ground Healthcare) Gold $3300 - EPO
- CareSource (Common Ground Healthcare) Gold $3300 - Vision Exam - EPO
- Better Together HMO Bronze 6500 Ded/8750 MOOP HSA - HMO
- Better Together HMO Bronze 7500 Ded/10000 MOOP HSA - HMO
- Better Together HMO Bronze No Medical Ded/10600 MOOP HSA - HMO
- Better Together HMO Gold 1500 Ded/8000 MOOP with Vision - HMO
- Better Together HMO Gold 2000 Ded/8200 MOOP - HMO
- Better Together HMO Gold 4000 Ded/4000 MOOP HSA - HMO
- Better Together HMO Platinum 750 Ded/2000 MOOP with Vision - HMO
- Better Together HMO Platinum No Ded/3300 MOOP - HMO
- Better Together HMO Platinum No Ded/5200 MOOP - HMO
- Better Together HMO Silver 5500 Ded/8500 MOOP with Vision - HMO
- Oak $1,300 Gold - PPO
- Oak $2,000 Standard Gold - PPO
- QUARTZ GUNDERSEN PERFORMANCE BRONZE $0 MEDICAL DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE BRONZE $10,150 DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE BRONZE (DENTAL & VISION) $0 MEDICAL DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE BRONZE (DENTAL & VISION) $10,150 DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE BRONZE (DENTAL & VISION) STANDARD EASY PRICING - HMO
- QUARTZ GUNDERSEN PERFORMANCE BRONZE STANDARD EASY PRICING - HMO
- QUARTZ GUNDERSEN PERFORMANCE CATASTROPHIC $10,600 DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE GOLD $4,000 DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE GOLD (DENTAL & VISION) $4,000 DED - HMO
- QUARTZ GUNDERSEN PERFORMANCE GOLD (DENTAL & VISION) STANDARD EASY PRICING - HMO
- Enrich $2,000 - 25% - HMO
- Enrich $3,500 - 30% - HMO
- Enrich $4,000 - 50% - HMO
- Enrich $5,000 HDHP - HMO
- Enrich $6,000 - 40% - HMO
- Enrich $7,500 - HMO
- Enrich $7,500 HDHP - HMO
- Enrich $9,500 - HMO
- Enrich Protection - HMO
- Premier $2,000 - 25% - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medicare Participation & PECOS Enrollment Status
Blaise Nemeth 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.
Blaise Nemeth 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: 42217697
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: I20061025000109
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
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1528027166, we treat the final digit (6) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 54. The final step is to find the difference between that total and the next multiple of ten (60 - 54 = 6).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 54 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1528027166, enumerated as an "individual" on March 22, 2006.
The provider is located at 5249 E TERRACE DR MADISON, WI 53718 and the phone number is (608) 265-1295.
Orthopaedic Surgery with taxonomy code 207XP3100X and a focus in Pediatric Orthopaedic Surgery.
The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield, Aspirus Health. Please consult your insurance carrier or call the provider to verify.
