DR. BRIAN M MACKEY O.D.
NPI 1609891092
Optometrist in Berkeley Heights, NJ

NPI Status: Active since July 13, 2006

Contact Information

369 SPRINGFIELD AVE
BERKELEY HEIGHTS, NJ
ZIP 07922
Phone: (908) 464-0123
Fax: (908) 665-2936

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

Individual
Male
Years of Experience 32
Optometrist
Accepts Medicare Approved Payment
PECOS Enrolled
Medicare Quality Reporting

About BRIAN MACKEY

This page provides the complete NPI Profile along with additional information for Brian Mackey, a provider established in Berkeley Heights, New Jersey with a medical specialization in Optometrist and more than 32 years of experience. He graduated from Illinois College Of Optometry At Chicago in 1994. The healthcare provider is registered in the NPI registry with number 1609891092 assigned on July 2006. The practitioner's primary taxonomy code is 152W00000X with license number 27OA05532300 (NJ). The provider is registered as an individual and his NPI record was last updated 13 years ago.

NPI: 1609891092
Provider Name: DR. BRIAN M MACKEY O.D.
Gender: Male
Entity Type: Individual
Location Address: 369 SPRINGFIELD AVE BERKELEY HEIGHTS, NJ 07922
Location Phone: (908) 464-0123
Location Fax: (908) 665-2936
Mailing Address: 77 GLENWOOD RD FANWOOD, NJ 07023
Mailing Phone: (908) 889-6256
Medical School Name: ILLINOIS COLLEGE OF OPTOMETRY AT CHICAGO
Graduation Year: 1994
Is Sole Proprietor?: No
Enumeration Date: 07-13-2006
Last Update Date: 04-27-2012
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: Optometrist
Taxonomy Code: 152W00000X
Type: Eye and Vision Services Providers
License No.: 27OA05532300
License State: NJ
Taxonomy Description: Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

Insurance Plans Accepted

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

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*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
U58539	MEDICARE UPIN (02)	NJ
006942	MEDICARE ID-TYPE UNSPECIFIED (04)	NJ

Medicare Participation & PECOS Enrollment Status

Brian Mackey 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.

Brian Mackey 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: 2860420379
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: I20050727000140
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

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 complete exam of visual system
Established patient office or other outpatient visit, 20-29 minutes
Established patient office or other outpatient visit, 30-39 minutes
Established patient problem focused exam of visual system
Exam of visual field with extended testing
New patient complete exam of visual system
Photography of the retina

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $36.21 for a new patient copayment and $19.77 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 07922 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99204

Average New Patient Price $144.86
Minimum New Patient Price $63.84
Maximum New Patient Price $190.92

Average New Patient Copayment $36.21
Minimum New Patient Copayment $15.96
Maximum New Patient Copayment $47.73

Established Patients Visit Costs *

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

Average Established Patient Price $79.09
Minimum Established Patient Price $20.97
Maximum Established Patient Price $155.92

Average Established Patient Copayment $19.77
Minimum Established Patient Copayment $5.24
Maximum Established Patient Copayment $38.98

* 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.

Quality Reporting

The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. 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
Care Plan	26%	65
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan
Pneumococcal Vaccination Status for Older Adults	95%	59
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	21%	58
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

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	6	0	9	8	9	1	0	9	2
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	6	0	9	16	9	2	0	18
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 6 + 0 + 9 + 1 + 6 + 9 + 2 + 0 + 1 + 8 + 24 = 68
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 68 = 2									2

The NPI number 1609891092 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location

The following 11 providers are registered at the same or nearby location.

DR. GARY LAWRENCE QUARTELLO DPM

Podiatrist

(Foot Surgery)