CAROLINE CRISTINA NITSCHMANN MD
NPI 1538483003
Obstetrics & Gynecology - Gynecologic Oncology in Burlington, MA

Quality Rating: 91.41 out of 100 score

NPI Status: Active since March 26, 2010

Contact Information

41 MALL ROAD LAHEY HOSPITAL AND MEDICAL CENTER
BURLINGTON, MA
ZIP 01805
Phone: (781) 744-8560

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Table of Contents

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Medicare Participation & PECOS Status
Areas of Expertise
Physician Visit Costs
Overall Quality Performance
Hospital Affiliations - Privileges
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Female
Years of Experience 16
Obstetrics & Gynecology
Gynecologic Oncology
Accepts Insurance
Accepts Medicare Approved Payment
PECOS Enrolled

About CAROLINE NITSCHMANN

This page provides the complete NPI Profile along with additional information for Caroline Nitschmann, a women's health care provider established in Burlington, Massachusetts with a medical specialization in Obstetrics & Gynecology, focusing in gynecologic oncology and more than 16 years of experience. The healthcare provider is registered in the NPI registry with number 1538483003 assigned on March 2010. The practitioner's primary taxonomy code is 207VX0201X with license number 273046 (MA). The provider is registered as an individual and her NPI record was last updated 8 years ago.

NPI: 1538483003
Provider Name: CAROLINE CRISTINA NITSCHMANN MD
Gender: Female
Entity Type: Individual
Location Address: 41 MALL ROAD LAHEY HOSPITAL AND MEDICAL CENTER BURLINGTON, MA 01805
Location Phone: (781) 744-8560
Mailing Address: 41 MALL ROAD LAHEY HOSPITAL AND MEDICAL CENTER BURLINGTON, MA 01805
Mailing Phone: (781) 744-8560
Medical School Name: OTHER
Graduation Year: 2010
Is Sole Proprietor?: No
Enumeration Date: 03-26-2010
Last Update Date: 05-23-2018
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Women's health care providers like Caroline Nitschmann treat and diagnose diseases and conditions that affect a woman's physical and emotional health. Women's health professionals come from a variety of different specialties, including obstetrician/gynecologists, general surgeons, perinatologists, physician assistants, nurse practitioners or nurse midwives. A women's health provider might help you with family planning, breast care, pregnancy and child birth, osteoporosis, menopause, heart disease, etc.

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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: Obstetrics & Gynecology Gynecologic Oncology
Taxonomy Code: 207VX0201X
Type: Allopathic & Osteopathic Physicians
License No.: 273046
License State: MA
Taxonomy Description: An obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and resulting complications.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Anthem Blue Cross and Blue Sheld

Anthem Bronze Preferred Blue PPO 6000/20%/8000 w/HSA - PPO
Anthem Bronze Preferred Blue PPO 7000/50%/8000 w/HSA - PPO
Anthem Bronze Preferred Blue PPO 7500/30%/10000 Value - PPO
Anthem Bronze Preferred Blue PPO 8500/50%/9200 - PPO
Anthem Gold Preferred Blue PPO 1000/20%/7500 - PPO
Anthem Gold Preferred Blue PPO 2000/0%/6500 RxD - PPO
Anthem Gold Preferred Blue PPO 2000/10%/4600 w/HSA - PPO
Anthem Gold Preferred Blue PPO 2000/10%/7500 - PPO
Anthem Gold Preferred Blue PPO 2000/20%/4600 w/HSA - PPO
Anthem Gold Preferred Blue PPO 3000/0%/7500 RxD - PPO
Anthem Gold Preferred Blue PPO 500/30%/9000 - PPO
Anthem Platinum Preferred Blue PPO 250/10%/3500 - PPO
Anthem Silver Preferred Blue PPO 2500/30%/10000 Value - PPO
Anthem Silver Preferred Blue PPO 3000/30%/9000 Value - PPO
Anthem Silver Preferred Blue PPO 3500/20%/10000 - PPO
Anthem Silver Preferred Blue PPO 3500/20%/7250 w/HSA - PPO
Anthem Silver Preferred Blue PPO 4000/0%/9000 - PPO
Anthem Silver Preferred Blue PPO 4000/0%/9000 RxD - PPO
Anthem Silver Preferred Blue PPO 4000/10%/7250 w/HSA - PPO
Anthem Silver Preferred Blue PPO 4000/20%/8500 - PPO

Anthem Blue Cross and Blue Shield

Anthem Bronze Pathway X Enhanced 6000/35% HSA - HMO
Anthem Bronze Pathway X Enhanced 7000/0% ($0 Virtual PCP + $0 Select Drugs) - HMO
Anthem Bronze Pathway X Enhanced 7500/50% ($0 Virtual PCP + $0 Select Drugs) Standard - HMO
Anthem Catastrophic Pathway X Enhanced - HMO
Anthem Gold Pathway X Enhanced 1200/20% ($0 Virtual PCP + $0 Select Drugs) - HMO
Anthem Gold Pathway X Enhanced 2000/25% ($0 Virtual PCP + $0 Select Drug) Standard - HMO
Anthem Gold Pathway X Enhanced 700/40% ($0 Virtual PCP + $0 Select Drugs) - HMO
Anthem Heart Healthy Bronze Pathway X Enhanced 6000/40% ($0 Virtual PCP + $0 Select Drugs) - HMO
Anthem Heart Healthy Silver Pathway X Enhanced 4000/0% ($0 Virtual PCP + $0 Select Drugs) - HMO
Anthem Silver Pathway X Enhanced 4500/20% HSA - HMO
Anthem Silver Pathway X Enhanced 5500/20% ($0 Virtual PCP + $0 Select Drugs) - HMO
Anthem Silver Pathway X Enhanced 6000/40% ($0 Virtual PCP + $0 Select Drugs) Standard - HMO
Anthem Bronze Access Blue New England HMO 6000/20%/8000 w/HSA - HMO
Anthem Bronze Access Blue New England HMO 7000/50%/8000 w/HSA - HMO
Anthem Bronze Access Blue New England HMO 7500/30%/10000 Value - HMO
Anthem Bronze Access Blue New England HMO 8500/50%/9200 - HMO
Anthem Bronze Pathway X HMO 6000/20%/8000 w/HSA - HMO
Anthem Bronze Pathway X HMO 7000/50%/8000 w/HSA - HMO
Anthem Bronze Pathway X HMO 7500/30%/10000 Value - HMO
Anthem Bronze Pathway X HMO 8500/50%/9200 - HMO

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

Medicare Participation & PECOS Enrollment Status

Caroline Nitschmann 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.

Caroline Nitschmann 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: 7719144120
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: I20171010000347, I20190606000377
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

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Established patient office or other outpatient visit, 40-54 minutes
Hernia repair (minimally invasive)
Imaging of lymph nodes during surgery
Melanoma (skin cancer) excision
New patient office or other outpatient visit, 45-59 minutes
New patient office or other outpatient visit, 60-74 minutes
Removal of uterus, tubes, and/or ovaries through abdomen using an endoscope, 250.0 g or less
Telephone medical discussion with physician, 11-20 minutes
Telephone medical discussion with physician, 21-30 minutes

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $47.46 for a new patient copayment and $27.79 for an established patient copayment.

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 01805 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99205

Average New Patient Price $189.86
Minimum New Patient Price $63.72
Maximum New Patient Price $189.86

Average New Patient Copayment $47.46
Minimum New Patient Copayment $15.93
Maximum New Patient Copayment $47.46

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

Average Established Patient Price $111.18
Minimum Established Patient Price $21.07
Maximum Established Patient Price $155.29

Average Established Patient Copayment $27.79
Minimum Established Patient Copayment $5.26
Maximum Established Patient Copayment $38.82

* 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 provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 91.41, 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 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: 91.41 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: 76.87

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: 100

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.

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

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. Caroline Nitschmann is affiliated with the following medical facilities:

Hospital Name	Address	Phone	Hospital Type
NORTHEAST HOSPITAL CORPORATION	85 HERRICK STREET BEVERLY, MA 01915	(978) 922-3000	Acute Care Hospitals
BETH ISRAEL DEACONESS MEDICAL CENTER	330 BROOKLINE AVENUE BOSTON, MA 02215	(617) 667-7000	Acute Care Hospitals
LAHEY HOSPITAL & MEDICAL CENTER, BURLINGTON	41 & 45 MALL ROAD BURLINGTON, MA 01803	(781) 744-5100	Acute Care Hospitals

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 1538483003, we treat the final digit (3) 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 67. The final step is to find the difference between that total and the next multiple of ten (70 - 67 = 3).

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.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 6

Pos 4

Unchanged

Pos 5

Doubled → 8

Pos 6

Unchanged

Pos 7

Doubled → 6

Pos 8

Unchanged

Pos 9

Doubled → 0

Check

Target digit

Regular digit Doubled digit Check digit

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.

1 → 2 3 → 6 4 → 8 3 → 6 0 → 0

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 5 + 6 + 8 + 8 + 8 + 6 + 0 + 0 + 24 = 67

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 67 is 70. The difference is the calculated check digit.

70 - 67 = 3

This NPI is valid

The calculated check digit is 3, which matches the last digit of 1538483003.