DR. JOSEPH MICHEAL CAPORUSSO DPM PA
NPI 1528062213
Podiatrist in Mcallen, TX


Quality Rating: 93.45 out of 100 score

NPI Status: Active since June 09, 2005

Contact Information

812 LINDBERG AVE
MCALLEN, TX
ZIP 78501
Phone: (956) 971-9107
Fax: (956) 971-9109

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  • Individual
  • Male
  • Years of Experience 35
  • Podiatrist
  • PECOS Enrolled
  • Accepts Medicare Approved Payment
  • Medicare Quality Reporting

About JOSEPH CAPORUSSO

Joseph Caporusso is a provider established in Mcallen, Texas and his medical specialization is Podiatrist with more than 35 years of experience. He graduated from Temple University School Of Podiatric Medicine in 1989. The healthcare provider is registered in the NPI registry with number 1528062213 assigned on June 2005. The practitioner's primary taxonomy code is 213E00000X with license number 1091 (TX). The provider is registered as an individual and his NPI record was last updated 2 years ago.

NPI
1528062213
Provider Name
DR. JOSEPH MICHEAL CAPORUSSO DPM PA
Gender
Male
Entity Type
Individual
Location Address
812 LINDBERG AVE MCALLEN, TX 78501
Location Phone
(956) 971-9107
Location Fax
(956) 971-9109
Mailing Address
812 LINDBERG AVE MCALLEN, TX 78501
Mailing Phone
(956) 971-9107
Mailing Fax
(956) 971-9109
Medical School Name
TEMPLE UNIVERSITY SCHOOL OF PODIATRIC MEDICINE
Graduation Year
1989
Is Sole Proprietor?
No
Enumeration Date
06-09-2005
Last Update Date
10-03-2022
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A podiatrist like Joseph Caporusso provides medical and surgical care for people with foot, ankle, and lower leg issues. Podiatrists treat foot and ankle ailments like calluses, ingrown toenails, heel spurs, arthritis, congenital foot deformities, foot problems associated with diabetes and arch problems.

Joseph Caporusso 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 93.45, 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 following quality measures were reported for this provider: collection and follow-up on patient experience and satisfaction data on beneficiary engagement, diabetes: foot exam, diabetes: medical attention for nephropathy, documentation of current medications in the medical record, e-prescribing, falls: screening for future fall risk, health information exchange, medication reconciliation, patient-specific education, pneumococcal vaccination status for older adults, preventive care and screening: body mass index (bmi) screening and follow-up plan, preventive care and screening: influenza immunization, provide patient access, security risk analysis and use of high-risk medications in the elderly.

The typical physician office visit costs for Medicare beneficiaries in this area are: $21.84 for a new patient copayment and $17.81 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

Podiatrist

Taxonomy Code
213E00000X
Type
Podiatric Medicine & Surgery Service Providers
License No.
1091
License State
TX
Taxonomy Description
A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.

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

    • Gold 3: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 - HMO
    • Gold 4: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 - HMO
    • Gold S: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 - HMO
    • Silver 1: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 - HMO
    • Silver 5: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 - HMO
  • Ambetter from Arizona Complete Health

    • Choice Bronze HSA - HMO
    • Choice Bronze HSA + Vision + Adult Dental - HMO
    • Clear Gold - HMO
    • Clear Gold + Vision + Adult Dental - HMO
    • Clear Silver - HMO
  • Ambetter from Arkansas Health & Wellness

    • Choice Bronze HSA (QualChoice) - POS
    • Complete Gold - PPO
    • Complete Gold + Vision + Adult Dental - PPO
    • Complete Silver - PPO
    • Complete Silver + Vision + Adult Dental - PPO
  • Ambetter from Louisiana Healthcare Connections

    • Clear Silver - EPO
    • Clear Silver + Vision + Adult Dental - EPO
    • Complete Gold - EPO
    • Complete Gold + Vision + Adult Dental - EPO
    • Elite Bronze - EPO
  • Ambetter from Superior HealthPlan

    • Ambetter Virtual Access Gold (Virtual PCP selection required) - HMO
    • Ambetter Virtual Access Silver (Virtual PCP selection required) - HMO
    • Clear Gold - EPO
    • Clear Gold + Vision + Adult Dental - EPO
    • Clear Silver - EPO
  • Ambetter of Oklahoma

    • Clear Gold - PPO
    • Clear Gold + Vision + Adult Dental - PPO
    • Clear Silver - PPO
    • Clear Silver + Vision + Adult Dental - PPO
    • Complete Silver - PPO
  • Blue Cross and Blue Shield of Texas

    • Blue Advantage Bronze HMO℠ 204 - HMO
    • Blue Advantage Bronze HMO℠ 301 - HMO
    • Blue Advantage Bronze HMO℠ 302 - HMO
    • Blue Advantage Bronze HMO℠ 707 - HMO
    • Blue Advantage Gold HMO℠ 206 - HMO
  • Molina Healthcare

    • Gold 1 - HMO
    • Gold 1 with Adult Vision Services - HMO
    • Gold 8 - HMO
    • Silver 1 250 - HMO
    • Silver 1 250 with Adult Vision Services - HMO
  • UnitedHealthcare

    • UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Insulin) - HMO
    • UHC Bronze Standard - HMO
    • UHC Bronze Value ($0 Virtual Urgent Care + $0 PCP Visits, $3 Tier 2 Rx, $0 Insulin) - HMO
    • UHC Bronze Value HSA - HMO
    • UHC Gold Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, $0 Insulin) - HMO
  • Medicare

  • Medicaid


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

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
135012605OTHER (01)TXTPI INDIVIDUAL
157919501MEDICAID (05)TX 
018805401MEDICAID (05)TX 

PECOS Enrollment and Medicare Participation Status

Joseph Caporusso 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) and a Home Health Agency (HHA).

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: 143326751

    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: I20100628000112

    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: No

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.

Prosthetic and Orthotic Devices

  • Prosthetic/Orthotic devices (D1F)

    For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe (HCPCS:A5500)

    1 DME suppliers used 62 Medicare Claims 124 Services Paid

  • Prosthetic/Orthotic devices (D1F)

    For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each (HCPCS:A5512)

    1 DME suppliers used 57 Medicare Claims 339 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 78501 ZIP code area.

New Patients Visit Costs *

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

  • Average New Patient Price $87.36
  • Minimum New Patient Price $56.75
  • Maximum New Patient Price $172.6
  • Average New Patient Copayment $21.84
  • Minimum New Patient Copayment $14.18
  • Maximum New Patient Copayment $43.15

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

  • Average Established Patient Price $71.24
  • Minimum Established Patient Price $17.72
  • Maximum Established Patient Price $141.29
  • Average Established Patient Copayment $17.81
  • Minimum Established Patient Copayment $4.43
  • Maximum Established Patient Copayment $35.32

* 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: 93.45 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: 92.29

    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: N/A

    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.

Quality Reporting

The following quality measures meet Medicare's statistical reporting standards for the year 2018. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

Quality Measure Performance Number of Patients
Collection and follow-up on patient experience and satisfaction data on beneficiary engagementYesN/A
Collection and follow-up on patient experience and satisfaction data on beneficiary engagement, including development of improvement plan.
Diabetes: Foot Exam 48% 826
The percentage of patients 18-75 years of age with diabetes (type 1 and type 2) who received a foot exam (visual inspection and sensory exam with mono filament and a pulse exam) during the measurement year
Diabetes: Medical Attention for Nephropathy 17% 826
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
Documentation of Current Medications in the Medical Record 39% 4400
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration
e-Prescribing 40% 42
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Falls: Screening for Future Fall Risk 84% 524
Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period
Health Information Exchange 1% 116
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for at least one transition of care or referral.
Medication Reconciliation 58% 3407
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
Patient-Specific Education 100% 2699
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
Pneumococcal Vaccination Status for Older Adults 59% 1006
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 86% 1739
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2
Preventive Care and Screening: Influenza Immunization 71% 973
Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization
Provide Patient Access 70% 2699
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information.
Security Risk AnalysisYesN/A
Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.
Use of High-Risk Medications in the Elderly 1% "Inverse Quality Measure"
This is an inverse quality measure, a lower rate means the provider is rated better.
1005
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication. 2) Percentage of patients who were ordered at least two of the same high-risk medication

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.

  • 405

    Removal of tissue from 6 or more finger or toe nails (HCPCS:11721)

  • 238

    Removal of tissue from 1 to 5 finger or toe nails (HCPCS:11720)

  • 213

    X-ray of foot, minimum of 3 views (HCPCS:73630)

  • 62

    Removal of skin and tissue first 20 sq cm or less (HCPCS:11042)

  • 52

    Removal of 2 to 4 thickened skin growths (HCPCS:11056)

  • 45

    Removal of single thickened skin growth (HCPCS:11055)

  • 21

    Injection, dexamethasone sodium phosphate, 1 mg (HCPCS:J1100)

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. Joseph Caporusso is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
DOCTORS HOSPITAL AT RENAISSANCE5501 SOUTH MCCOLL
EDINBURG, TX 78539
(956) 362-8677Acute 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.
1528062213
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
254806422
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 5 + 4 + 8 + 0 + 6 + 4 + 2 + 2 + 24 = 57
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 57 = 33

The NPI number 1528062213 is valid because the calculated check digit 3 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 6 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1114922697DR. BRYAN J PRUKOP DPM
Individual
Podiatrist812 LINDBERG AVE
MCALLEN, TX 78501
(956) 971-9107
1174172506JOSEPH M CAPORUSSO DPM PA
Organization
Podiatrist (Foot & Ankle Surgery)812 LINDBERG AVE
MCALLEN, TX 78501
(956) 971-9107
1255401196JOSEPH M CAPORUSSO DPM PA
Organization
Podiatrist (Foot & Ankle Surgery)812 LINDBERG AVE
MCALLEN, TX 78501
(956) 971-9107
1265436828DR. JOSEPH F BENDER DPM
Individual
Podiatrist812 LINDBERG AVE
MCALLEN, TX 78501
(956) 971-9107
1487033502DR. AMORY N BAKER D.P.M.
Individual
Podiatrist (Foot & Ankle Surgery)812 LINDBERG AVE
MCALLEN, TX 78501
(956) 971-9107
1609869486DR. OSCAR LUIS CORRAL DPM
Individual
Podiatrist (Foot & Ankle Surgery)812 LINDBERG AVE COMPLETE FAMILY FOOT CARE
MCALLEN, TX 78501
(956) 971-9107

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1528062213, enumerated in the NPI registry as an "individual" on June 09, 2005

The provider is located at 812 Lindberg Ave Mcallen, Tx 78501 and the phone number is (956) 971-9107

The provider's speciality is Podiatrist with taxonomy code 213E00000X

The provider has more than 35 years of experience. He graduated from Temple University School Of Podiatric Medicine in 1989.

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

Yes, as of May 10, 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) and a Home Health Agency (HHA).

The provider has an overall high rating in the following quality measures: quality clinical practices and patient outcomes and experiences.

Medicare beneficiaries should expect a typical cost of $87.36 with an average copayment of $21.84 for new patient appointments. Established patients should expect a typical charge of $71.24 and an average copayment of 17.81. 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: Removal of tissue from 6 or more finger or toe nails, Removal of tissue from 1 to 5 finger or toe nails, X-ray of foot, minimum of 3 views, Removal of skin and tissue first 20 sq cm or less, Removal of 2 to 4 thickened skin growths, Removal of single thickened skin growth and Injection, dexamethasone sodium phosphate, 1 mg.

The practitioner is affiliated to the following hospital(s): DOCTORS HOSPITAL AT RENAISSANCE. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

This NPI record was last updated on June 09, 2005. 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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