PAUL D MUMMA D.O.
NPI 1619958121
Family Medicine in Crooksville, OH
NPI Status: Active since November 10, 2005
Contact Information
721 CHINA ST
CROOKSVILLE, OH
ZIP 43731
Phone: (740) 697-0173
Fax: (740) 982-5551
- Individual
- Male
- Family Medicine
- Accepts Insurance
- PECOS Enrolled
- Medicare Quality Reporting
About PAUL MUMMA
This page provides the complete NPI Profile along with additional information for Paul Mumma, a primary care provider established in Crooksville, Ohio with a medical specialization in Family Medicine. The healthcare provider is registered in the NPI registry with number 1619958121 assigned on November 2005. The practitioner's primary taxonomy code is 207Q00000X with license number 34004248M (OH). The provider is registered as an individual and his NPI record was last updated 14 years ago.
- NPI
- 1619958121
- Provider Name
- PAUL D MUMMA D.O.
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 721 CHINA ST CROOKSVILLE, OH 43731
- Location Phone
- (740) 697-0173
- Location Fax
- (740) 982-5551
- Mailing Address
- PO BOX 1821 ZANESVILLE, OH 43702
- Mailing Phone
- (740) 455-3304
- Mailing Fax
- (740) 982-5551
- Is Sole Proprietor?
- No
- Enumeration Date
- 11-10-2005
- Last Update Date
- 01-04-2012
- Code Navigator
A primary care provider (PCP) like Paul Mumma 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 .
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
Family Medicine
- Taxonomy Code
- 207Q00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 34004248M
- License State
- OH
- 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:
- Bronze 7500 $25 Generic Drugs - HMO
- Bronze 7500 $25 Generic Drugs + Adult Vision & Fitness - HMO
- Core Gold 1500 $10 Generic Drugs - HMO
- Core Gold 1500 $10 Generic Drugs + Adult Vision & Fitness - HMO
- Diabetes Gold 3000 $0 Chronic Care Drugs & Services - HMO
- Diabetes Gold 3000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness - HMO
- Diabetes Silver 5000 $0 Chronic Care Drugs & Services - HMO
- Diabetes Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness - HMO
- Gold 2000 $15 Generic Drugs - HMO
- Gold 2000 $15 Generic Drugs + Adult Vision & Fitness - HMO
- HDHP Preventive Silver 5500 $0 Chronic Care Drugs - HMO
- Healthy Heart Gold 3000 $0 Chronic Care Drugs & Services - HMO
- Healthy Heart Gold 3000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness - HMO
- Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services - HMO
- Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness - HMO
- Low Premium Bronze 10600 $25 Generic Drugs - HMO
- Low Premium Bronze 10600 $25 Generic Drugs + Adult Vision & Fitness - HMO
- Low Premium Silver 6200 $3 Generic Drugs - HMO
- Low Premium Silver 6200 $3 Generic Drugs + Adult Vision & Fitness - HMO
- Silver 6000 $20 Generic Drugs - HMO
- Bronze $8,300 w/ Adult Dental ON-EX - HMO
- Bronze $8,300 w/ Virtual & Wellness ON-EX - HMO
- Bronze HSA $7,300 ON-EX - HMO
- Bronze Standard w/ Virtual & Wellness - HMO
- Gold $1,000 w/ Adult Dental ON-EX - HMO
- Gold $1,000 w/ Virtual & Wellness ON-EX - HMO
- Gold $500 w/ Virtual & Wellness ON-EX - HMO
- Gold Standard w/ Virtual & Wellness - HMO
- Silver $5,000 w/ Adult Dental ON-EX - HMO
- Silver $5,000 w/ Virtual & Wellness ON-EX - HMO
- Silver $5,800 w/ Virtual & Wellness ON-EX - HMO
- Silver Standard w/ Virtual & Wellness - HMO
- Molina Bronze Enhanced 3500 - HMO
- Molina Bronze Enhanced 3500 Plus with Adult Dental and Vision - HMO
- Molina Bronze Enhanced 3500 Plus with Adult Vision - HMO
- Molina Bronze Saver 7000 - HMO
- Molina Bronze Saver 7000 Plus with Adult Dental and Vision - HMO
- Molina Bronze Saver 7000 Plus with Adult Vision - HMO
- Molina Bronze Smart Heart Health - HMO
- Molina Bronze Standard - HMO
- Molina Gold Core 1640 - HMO
- Molina Gold Core 1640 Plus with Adult Dental and Vision - HMO
- Molina Gold Core 1640 Plus with Adult Vision - HMO
- Molina Gold Enhanced 895 - HMO
- Molina Gold Enhanced 895 Plus with Adult Dental and Vision - HMO
- Molina Gold Enhanced 895 Plus with Adult Vision - HMO
- Molina Gold Smart Heart Health - HMO
- Molina Gold Standard - HMO
- Molina Silver Core - HMO
- Molina Silver Core Plus with Adult Dental and Vision - HMO
- Molina Silver Core Plus with Adult Vision - HMO
- Molina Silver Saver with Four Free PCP Visits - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
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 |
|---|---|---|---|
| A82625 | MEDICARE UPIN (02) | OH | |
| 0645136 | MEDICAID (05) | OH | |
| MU0591942 | MEDICARE ID-TYPE UNSPECIFIED (04) | OH |
Medicare Participation & PECOS Enrollment Status
Paul Mumma 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
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
DME-Other DME (DE017N)
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (HCPCS:A4253)
1 DME suppliers used 11 Medicare Claims 28 Services Paid
DME-Medical/Surgical Supplies (DA023N)
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing (HCPCS:A6196)
2 DME suppliers used 22 Medicare Claims 764 Services Paid
DME-Medical/Surgical Supplies (DA023N)
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing (HCPCS:A6219)
2 DME suppliers used 12 Medicare Claims 485 Services Paid
DME-Hospital Beds (DB000N)
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress (HCPCS:E0260)
2 DME suppliers used 17 Medicare Claims 17 Services Paid
DME-Oxygen and Supplies (DC000N)
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
DME-Other DME (DE005N)
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) (HCPCS:E0466)
1 DME suppliers used 12 Medicare Claims 12 Services Paid
DME-Oxygen and Supplies (DC002N)
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)
2 DME suppliers used 20 Medicare Claims 20 Services Paid
Orthotic Devices
DME-Orthotic Devices (DF000N)
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) (HCPCS:A4311)
1 DME suppliers used 13 Medicare Claims 13 Services Paid
DME-Orthotic Devices (DF000N)
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) (HCPCS:A4314)
2 DME suppliers used 35 Medicare Claims 35 Services Paid
DME-Orthotic Devices (DF000N)
Urinary catheter anchoring device, adhesive skin attachment, each (HCPCS:A4333)
1 DME suppliers used 18 Medicare Claims 216 Services Paid
DME-Orthotic Devices (DF000N)
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each (HCPCS:A4357)
2 DME suppliers used 38 Medicare Claims 38 Services Paid
DME-Orthotic Devices (DF000N)
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each (HCPCS:A4358)
1 DME suppliers used 13 Medicare Claims 26 Services Paid
Unknown
Other-Enteral and Parenteral (OB006N)
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape (HCPCS:B4035)
2 DME suppliers used 23 Medicare Claims 564 Services Paid
Other-Enteral and Parenteral (OB006N)
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (HCPCS:B4152)
2 DME suppliers used 19 Medicare Claims 9032 Services Paid
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.
Advance care planning, first 30 minutes
Advance care planning, first 30 minutes
Follow-up nursing facility visit per day, typically 10 minutes
Follow-up nursing facility visit per day, typically 10 minutes
Follow-up nursing facility visit per day, typically 15 minutes
Follow-up nursing facility visit per day, typically 15 minutes
Follow-up nursing facility visit per day, typically 25 minutes
Follow-up nursing facility visit per day, typically 25 minutes
Follow-up nursing facility visit per day, typically 35 minutes
Follow-up nursing facility visit per day, typically 35 minutes
Initial nursing facility visit per day, typically 35 minutes
Initial nursing facility visit per day, typically 45 minutes
Initial nursing facility visit per day, typically 45 minutes
Nursing facility annual assessment, typically 30 minutes
Nursing facility discharge management, more than 30 minutes
Advance care planning is a process where you discuss your healthcare preferences with your doctor. This conversation, lasting up to 30 minutes, helps ensure your wishes are respected if you're unable to communicate them in the future. It's about your care, your way.
This service was performed 20 times for 19 patientsAdvance care planning is a process where you discuss your healthcare preferences with your doctor. This conversation, lasting up to 30 minutes, helps ensure your wishes are respected if you're unable to communicate them in the future. It's about your care, your way.
This service was performed 15 times for 15 patientsA follow-up nursing facility visit per day typically lasts about 10 minutes. This service involves a healthcare professional checking on your health status, answering any questions you may have, and monitoring your progress. This routine check ensures your recovery is on track and any concerns are addressed promptly.
This service was performed 13 times for 12 patientsA follow-up nursing facility visit per day typically lasts about 10 minutes. This service involves a healthcare professional checking on your health status, answering any questions you may have, and monitoring your progress. This routine check ensures your recovery is on track and any concerns are addressed promptly.
This service was performed 38 times for 36 patientsA follow-up nursing facility visit per day is a daily check-up service provided by healthcare professionals. It lasts around 15 minutes and involves assessing your health status, monitoring your recovery progress, and addressing any concerns you may have about your health or treatment.
This service was performed 75 times for 55 patientsA follow-up nursing facility visit per day is a daily check-up service provided by healthcare professionals. It lasts around 15 minutes and involves assessing your health status, monitoring your recovery progress, and addressing any concerns you may have about your health or treatment.
This service was performed 194 times for 134 patientsA follow-up nursing facility visit per day is a daily check-in by a healthcare professional. This 25-minute visit typically involves monitoring your health progress, addressing any concerns, and adjusting treatment plans as necessary. It's a vital part of ensuring your ongoing wellbeing.
This service was performed 183 times for 114 patientsA follow-up nursing facility visit per day is a daily check-in by a healthcare professional. This 25-minute visit typically involves monitoring your health progress, addressing any concerns, and adjusting treatment plans as necessary. It's a vital part of ensuring your ongoing wellbeing.
This service was performed 311 times for 171 patientsA follow-up nursing facility visit is a routine check-up that typically lasts about 35 minutes. During this visit, your health status is evaluated, any changes in your condition are noted, and necessary adjustments to your care plan are made. It's an essential part of maintaining your health.
This service was performed 28 times for 26 patientsA follow-up nursing facility visit is a routine check-up that typically lasts about 35 minutes. During this visit, your health status is evaluated, any changes in your condition are noted, and necessary adjustments to your care plan are made. It's an essential part of maintaining your health.
This service was performed 28 times for 23 patientsAn initial nursing facility visit per day is a service where a healthcare professional spends about 35 minutes assessing a patient's health status. This includes reviewing medical history, conducting a physical exam, and developing a care plan based on the patient's needs.
This service was performed 23 times for 23 patientsAn initial nursing facility visit is your first meeting with your healthcare team at a nursing facility. Lasting typically 45 minutes, this appointment involves a comprehensive health assessment and the creation of your personalized care plan. It's a crucial step to ensure your health and well-being.
This service was performed 368 times for 326 patientsAn initial nursing facility visit is your first meeting with your healthcare team at a nursing facility. Lasting typically 45 minutes, this appointment involves a comprehensive health assessment and the creation of your personalized care plan. It's a crucial step to ensure your health and well-being.
This service was performed 37 times for 36 patientsAn annual assessment at a nursing facility is a routine check-up that typically lasts about 30 minutes. It's a chance for healthcare professionals to evaluate your overall health and wellness, monitor any ongoing conditions, and adjust care plans as needed.
This service was performed 11 times for 11 patientsNursing facility discharge management over 30 minutes is a comprehensive process where a healthcare team prepares you for leaving the facility. It involves creating a tailored plan, coordinating care, and ensuring a smooth transition to your next care setting.
This service was performed 32 times for 31 patientsPhysician 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 43731 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $84.72
- Minimum New Patient Price $54.34
- Maximum New Patient Price $166.65
- Average New Patient Copayment $21.18
- Minimum New Patient Copayment $13.58
- Maximum New Patient Copayment $41.66
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $96.44
- Minimum Established Patient Price $17.1
- Maximum Established Patient Price $135.4
- Average Established Patient Copayment $24.11
- Minimum Established Patient Copayment $4.27
- Maximum Established Patient Copayment $33.85
* 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 |
|---|---|---|
| Colorectal Cancer Screening | 53% | 177 |
| Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer | ||
| Pneumococcal Vaccination Status for Older Adults | 30% | 205 |
| 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 | 26% | 286 |
| 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: Screening for Depression and Follow-Up Plan | 40% | 228 |
| Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen | ||
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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 1619958121, we treat the final digit (1) 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 69. The final step is to find the difference between that total and the next multiple of ten (70 - 69 = 1).
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.
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.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 69 is 70. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1619958121, enumerated as an "individual" on November 10, 2005.
The provider is located at 721 CHINA ST CROOKSVILLE, OH 43731 and the phone number is (740) 697-0173.
Family Medicine with taxonomy code 207Q00000X.
The provider might be accepting Accepts: CareSource, MedMutual, Molina Healthcare, Medicare. Please consult your insurance carrier or call the provider to verify.
