RILEY NELSON MD
NPI 1578657706
Family Medicine in Isleta, NM
NPI Status: Active since October 03, 2006
Contact Information
01 SAGEBRUSH
ISLETA, NM
ZIP 87022
Phone: (505) 869-4863
Fax: (505) 869-4881
- Individual
- Male
- Years of Experience 23
- Family Medicine
- PECOS Enrolled
- Accepts Medicare Approved Payment
About RILEY NELSON
Riley Nelson is a primary care provider established in Isleta, New Mexico and his medical specialization is Family Medicine with more than 23 years of experience. He graduated from University Of New Mexico School Of Medicine in 2001. The healthcare provider is registered in the NPI registry with number 1578657706 assigned on October 2006. The practitioner's primary taxonomy code is 207Q00000X with license number 2003-0359 (NM). The provider is registered as an individual and his NPI record was last updated 6 years ago.
- NPI
- 1578657706
- Provider Name
- RILEY NELSON MD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 01 SAGEBRUSH ISLETA, NM 87022
- Location Phone
- (505) 869-4863
- Location Fax
- (505) 869-4881
- Mailing Address
- 01 SAGEBRUSH ISLETA, NM 87022
- Mailing Phone
- (505) 869-4863
- Mailing Fax
- (505) 869-4881
- Medical School Name
- UNIVERSITY OF NEW MEXICO SCHOOL OF MEDICINE
- Graduation Year
- 2001
- Is Sole Proprietor?
- No
- Enumeration Date
- 10-03-2006
- Last Update Date
- 08-02-2018
- Code Navigator
A primary care provider (PCP) like Riley Nelson sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc
Riley Nelson 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 typical physician office visit costs for Medicare beneficiaries in this area are: $21.82 for a new patient copayment and $25.16 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
Family Medicine
- Taxonomy Code
- 207Q00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 2003-0359
- License State
- NM
- Taxonomy Description
- Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
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
- Clear Silver + Vision + Adult Dental - HMO
- Complete Gold - HMO
- Complete Gold + Vision + Adult Dental - HMO
- Complete Silver - HMO
- Complete Silver + Vision + Adult Dental - HMO
- Elite Bronze - HMO
- Elite Bronze + Vision + Adult Dental - HMO
- Elite Gold - HMO
- Elite Gold + Vision + Adult Dental - HMO
- Everyday Bronze - HMO
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
- Clear Silver + Vision + Adult Dental - EPO
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Complete Silver - EPO
- Complete Silver + Vision + Adult Dental - EPO
- Everyday Gold - EPO
- Everyday Gold + Vision + Adult Dental - EPO
- Focused Silver - EPO
- Focused Silver + Vision + Adult Dental - EPO
- Standard Ambetter Virtual Access Gold (Virtual PCP selection required) - HMO
Ambetter of Oklahoma
- Clear Gold - PPO
- Clear Gold + Vision + Adult Dental - PPO
- Clear Silver - PPO
- Clear Silver + Vision + Adult Dental - PPO
- Complete Silver - PPO
- Complete Silver + Vision + Adult Dental - PPO
- Elite Bronze - PPO
- Elite Bronze + Vision + Adult Dental - PPO
- Elite Gold - PPO
- Elite Gold + Vision + Adult Dental - PPO
- Everyday Bronze - PPO
- Everyday Bronze + Vision + Adult Dental - PPO
- Everyday Gold - PPO
- Everyday Gold + Vision + Adult Dental - PPO
- Focused Silver - PPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
PECOS Enrollment and Medicare Participation Status
Riley Nelson 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: 2961484191
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: I20040602001036
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
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.
Durable Medical Equipment
Oxygen and supplies (D1C)
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing (HCPCS:E0431)
2 DME suppliers used 15 Medicare Claims 15 Services Paid
Oxygen and supplies (D1C)
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)
3 DME suppliers used 17 Medicare Claims 17 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 87022 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $87.31
- Minimum New Patient Price $56.4
- Maximum New Patient Price $173.32
- Average New Patient Copayment $21.82
- Minimum New Patient Copayment $14.1
- Maximum New Patient Copayment $43.33
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $100.67
- Minimum Established Patient Price $17.1
- Maximum Established Patient Price $141.02
- Average Established Patient Copayment $25.16
- Minimum Established Patient Copayment $4.27
- Maximum Established Patient Copayment $35.25
* 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.
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.
- 164
Insertion of needle into vein for collection of blood sample (HCPCS:36415)
- 61
Injection beneath the skin or into muscle for therapy, diagnosis, or prevention (HCPCS:96372)
- 50
Hemoglobin a1c level (HCPCS:83036)
- 46
Automated urinalysis test (HCPCS:81003)
- 13
Routine ekg using at least 12 leads including interpretation and report (HCPCS:93000)
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. Riley Nelson is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| LOVELACE WOMEN'S HOSPITAL | 4701 MONTGOMERY BOULEVARD NE ALBUQUERQUE, NM 87109 | (505) 727-7805 | Acute 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. | |||||||||
| 1 | 5 | 7 | 8 | 6 | 5 | 7 | 7 | 0 | 6 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 5 | 14 | 8 | 12 | 5 | 14 | 7 | 0 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 5 + 1 + 4 + 8 + 1 + 2 + 5 + 1 + 4 + 7 + 0 + 24 = 64 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 64 = 6 | 6 | ||||||||
The NPI number 1578657706 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 14 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1285714121 | STEPHEN HUBBERT DDS Individual | Dentist | 01 SAGEBRUSH ISLETA, NM 87022 (505) 869-4863 |
| 1922188853 | KRYSTAL RACHELLE LUCERO LSW Individual | Social Worker | 01 SAGEBRUSH ISLETA, NM 87022 (505) 869-4863 |
| 1548342686 | JUAN J GUTIERREZ MSW,LISW Individual | Social Worker (Clinical) | 01 SAGEBRUSH ISLETA, NM 87022 (505) 869-4863 |
| 1376819680 | ANNIE FELICIA COOTS RN Individual | Registered Nurse (Community Health) | 01 SAGEBRUSH ISLETA, NM 87022 (505) 869-3200 |
| 1700947686 | MRS. ERICA LEANNE CARRASCO RPH Individual | Pharmacist (Pharmacotherapy) | 01 SAGEBRUSH ISLETA, NM 87022 (505) 869-3200 |
| 1174826515 | DR. MISTI MARLENE CHAVEZ PHARM D. Individual | Pharmacist (Pharmacotherapy) | 01 SAGEBRUSH ISLETA, NM 87022 (505) 869-3200 |
| 1104262914 | VERONICA SPRUNK RPH Individual | Pharmacist (Pharmacotherapy) | 01 SAGEBRUSH ISLETA, NM 87022 (505) 869-3200 |
| 1326590191 | PUEBLO OF ISLETA Organization | Clinic/Center (Urgent Care) | 01 SAGEBRUSH ISLETA, NM 87022 (505) 869-3200 |
| 1023191368 | PUEBLO OF ISLETA Organization | Ambulance | 01 SAGEBRUSH ISLETA, NM 87022 (505) 869-4863 |
| 1811547995 | MS. CHARLENE NICOLETTE GABALDON RN Individual | Registered Nurse (Hospice) | 01 SAGEBRUSH ISLETA, NM 87022 (505) 869-3200 |
| 1174169924 | SEAN A SALAZAR PT Individual | Physical Therapist | 01 SAGEBRUSH ISELETA, NM 87022 (505) 869-4398 |
| 1295312338 | SUSAN STEPHANIE CHEWIWI M.S. Individual | Registered Nurse (Community Health) | 01 SAGEBRUSH ISLETA, NM 87022 (505) 869-4864 |
| 1760050652 | MS. KAYLEE BRIANA CHAVEZ Individual | Counselor (Addiction (Substance Use Disorder)) | 01 SAGEBRUSH ISLETA, NM 87022 (505) 869-4866 |
| 1194738328 | PUEBLO OF ISLETA Organization | Clinic/Center | 01 SAGEBRUSH ISLETA, NM 87022 (505) 869-3200 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1578657706, enumerated in the NPI registry as an "individual" on October 03, 2006
The provider is located at 01 Sagebrush Isleta, Nm 87022 and the phone number is (505) 869-4863
The provider's speciality is Family Medicine with taxonomy code 207Q00000X
The provider has more than 23 years of experience. He graduated from University Of New Mexico School Of Medicine in 2001.
The provider might be accepting Accepts: Ambetter from Arizona Complete Health, Ambetter. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of May 17, 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), a Home Health Agency (HHA) and Power Mobility Devices.
Medicare beneficiaries should expect a typical cost of $87.31 with an average copayment of $21.82 for new patient appointments. Established patients should expect a typical charge of $100.67 and an average copayment of 25.16. 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: Insertion of needle into vein for collection of blood sample, Injection beneath the skin or into muscle for therapy, diagnosis, or prevention, Hemoglobin a1c level, Automated urinalysis test and Routine ekg using at least 12 leads including interpretation and report.
The practitioner is affiliated to the following hospital(s): LOVELACE WOMEN'S HOSPITAL. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
This NPI record was last updated on October 03, 2006. 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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