DANIEL R GACCIONE MD NPI 1538168117
Orthopaedic Surgery in Westerly, RI
About DANIEL R GACCIONE MD
Daniel Gaccione is a provider established in Westerly, Rhode Island and his medical specialization is Orthopaedic Surgery with more than 38 years of experience. He graduated from Warren Alpert Medical School Of Brown University in 1985. The NPI number of this provider is 1538168117 and was assigned on July 2005. The practitioner's primary taxonomy code is 207X00000X with license number MD07085 (RI). The provider is registered as an individual and his NPI record was last updated 10 years ago.
| NPI | 1538168117 |
| Provider Name | DANIEL R GACCIONE MD |
| Location Address | 101 AIRPORT RD WESTERLY, RI 02891 |
| Location Phone | (401) 596-0259 |
| Mailing Address | 101 AIRPORT RD. WESTERLY, RI 02891 |
| Gender | Male |
| NPI Entity Type | Individual |
| Medical School Name | WARREN ALPERT MEDICAL SCHOOL OF BROWN UNIVERSITY |
| Graduation Year | 1985 |
| Is Sole Proprietor? | No |
| Enumeration Date | 07-18-2005 |
| Last Update Date | 09-12-2013 |
Daniel Gaccione 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.
Daniel Gaccione 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 Lawrence & Memorial Hospital and Westerly Hospital.
The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 60, 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: preventive care and screening: body mass index (bmi) screening and follow-up plan.
The typical physician office visit costs for Medicare beneficiaries in this area are: $23.47 for a new patient copayment and $19.09 for an established patient copayment.
Primary Taxonomy
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.
| Taxonomy Code | 207X00000X |
| Classification | Orthopaedic Surgery |
| Type | Allopathic & Osteopathic Physicians |
| License No. | MD07085 |
| License State | RI |
| Taxonomy Description | An 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. |
Accepted Insurance
The NPI profile data indicates this provider might be enrolled and accepting health plans from the following insurance companies or healthcare programs:
- Anthem Blue Cross
- Blue Cross Blue Shield
- Medicaid
- Medicare
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Business Address
101 AIRPORT RD
WESTERLY, RI
ZIP 02891
Phone: (401) 596-0259
Fax: (401) 348-5934
Mailing Address
101 AIRPORT RD.
WESTERLY, RI
ZIP 02891
Phone: (401) 596-0259
Fax: (401) 348-5934
Location Map
PECOS Enrollment and Medicare Participation Status
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 ID | 1951449529 |
| PECOS Enrollment ID | I20111017000335 |
| 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 Imaging | Yes |
| Eligible order / refer Durable Medical Equipment | Yes |
| Eligible order / refer Home Health Agency (HHA) | Yes |
| Eligible order / refer Power Mobility Devices | Yes |
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 02891 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 |
| $61.15 | $184.88 | $93.88 |
| Minimum New Patient Copayment | Maximum New Patient Copayment | Typical New Patient Copayment |
| $15.28 | $46.22 | $23.47 |
| 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 |
| $19.15 | $151.08 | $76.36 |
| Minimum Established Patient Copayment | Maximum Established Patient Copayment | Typical Established Patient Copayment |
| $4.78 | $37.77 | $19.09 |
* 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. |
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| Promoting Interoperability (PI) | 25% | 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. |
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| Improvement Activities | 15% | N/A | |
|
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. |
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| 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. |
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| MIPS Final Score | - | 60 | |
| 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 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 |
|---|---|---|
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | 45% | 275 |
| 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 | ||
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.
- 324Aspiration and/or injection of large joint or joint capsule (HCPCS:20610)
- 44X-ray of knee, 3 views (HCPCS:73562)
- 18X-ray of shoulder, minimum of 2 views (HCPCS:73030)
- 18X-ray of hip with pelvis, 2-3 views (HCPCS:73502)
- 12Repair of knee joint (HCPCS:27447)
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. Daniel Gaccione is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | CMS Certification Number (CCN) | Overall Rating |
|---|---|---|---|---|---|
| LAWRENCE & MEMORIAL HOSPITAL | 365 MONTAUK AVE NEW LONDON, CT 6320 | (860) 442-0711 | Acute Care Hospitals | 70007 | |
| WESTERLY HOSPITAL | 25 WELLS STREET WESTERLY, RI 2891 | (401) 596-6000 | Acute Care Hospitals | 410013 |
Secondary Taxonomies
The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.
| No. | Taxonomy Code | Type | Classification | Specialization | License No. | State | Primary |
|---|---|---|---|---|---|---|---|
| 1 | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 034988 | CT | No | |
Taxonomy Description: an 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. | |||||||
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 |
|---|---|---|---|
| G19105 | MEDICARE UPIN (02) | ||
| 200001006 | MEDICARE ID-TYPE UNSPECIFIED (04) | CT | |
| 010034988CT02 | OTHER (01) | CT | ANTHEM BC/BS |
| 2V1386 | OTHER (01) | HEALTHNET | |
| 0901058 | OTHER (01) | UNITED HEALTH | |
| 22654-7 | OTHER (01) | RI | BCBS |
| 007009702 | MEDICARE ID-TYPE UNSPECIFIED (04) | RI | |
| 010007085RI02 | OTHER (01) | RI | ANTHEM BC/BS |
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. | |||||||||
| 1 | 5 | 3 | 8 | 1 | 6 | 8 | 1 | 1 | 7 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 5 | 6 | 8 | 2 | 6 | 16 | 1 | 2 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 5 + 6 + 8 + 2 + 6 + 1 + 6 + 1 + 2 + 24 = 63 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 63 = 7 | 7 | ||||||||
The NPI number 1538168117 is valid because the calculated check digit 7 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 |
|---|---|---|---|
| 1730376799 | COASTAL NEUROLOGY, INC Organization | Psychiatry & Neurology (Neurology) | 101 AIRPORT RD WESTERLY, RI 02891 (401) 596-6207 |
| 1730188327 | SOUNDVIEW ORTHOPAEDIC ASSOC. LLP Organization | Clinic/Center (Ambulatory Surgical) | 101 AIRPORT RD WESTERLY, RI 02891 (401) 596-0259 |
| 1962873240 | MRS. FATIMA MARTINS ABBOTT LICSW Individual | Social Worker (Clinical) | 101 AIRPORT RD WESTERLY, RI 02891 (401) 315-0143 |
| 1396262341 | JUSTINE PASCALE LCSW Individual | Social Worker (Clinical) | 101 AIRPORT RD WESTERLY, RI 02891 (401) 315-0143 |
| 1972568921 | MR. MICHAEL NEIL DEROSA LICSW Individual | Social Worker (Clinical) | 101 AIRPORT RD WESTERLY, RI 02891 (401) 855-0071 |
| 1154032761 | NORWICH ORTHOPEDIC GROUP, P.C. Organization | Orthopaedic Surgery | 101 AIRPORT RD WESTERLY, RI 02891 (860) 889-7345 |
Frequently Asked Questions
What is Daniel Gaccione MD NPI number?
The NPI number assigned to this healthcare provider is 1538168117, registered as an "individual" on July 18, 2005
Where is Daniel Gaccione MD located?
The provider is located at 101 Airport Rd Westerly, Ri 02891 and the phone number is (401) 596-0259
Which is Daniel Gaccione MD specialty?
The provider's speciality is Orthopaedic Surgery
How many years of experience does Daniel Gaccione MD have?
The provider has more than 38 years of experience. He graduated from Warren Alpert Medical School Of Brown University in 1985.
What insurance does Daniel Gaccione MD accept?
The provider might be accepting Anthem Blue Cross, Blue Cross Blue Shield, Medicaid and Medicare. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Is Daniel Gaccione MD registered in PECOS?
Yes, as of May 11, 2023 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a Medicare 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.
How much is a visit to Daniel Gaccione MD?
Medicare beneficiaries should expect a typical cost of $93.88 with an average copayment of $23.47 for new patient appointments. Established patients should expect a typical charge of $76.36 and an average copayment of 19.09. Please review your insurance plan or contact the provider directly to determine your specific costs.
What are some of the services provided by Daniel Gaccione MD?
The most common procedures or services performed by this practitioner are: Aspiration and/or injection of large joint or joint capsule, X-ray of knee, 3 views, X-ray of shoulder, minimum of 2 views, X-ray of hip with pelvis, 2-3 views and Repair of knee joint.
Is Daniel Gaccione MD affiliated to any hospitals?
The practitioner is affiliated to the following hospitals: LAWRENCE & MEMORIAL HOSPITAL and WESTERLY HOSPITAL. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
How do I update my NPI information?
The NPI record of Daniel Gaccione MD was last updated on July 18, 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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