JOHN J GONCALVES MD NPI 1639150949
Thoracic Surgery (Cardiothoracic Vascular Surgery) in Mineola, NY

Individual Male Years of Experience 29 Thoracic Surgery (Cardiothoracic Vascula... PECOS Enrolled Accepts Medicare Approved Payment MIPS Quality Score 95.4 Medicare Quality Reporting

About JOHN J GONCALVES MD

John Goncalves is a provider established in Mineola, New York and his medical specialization is Thoracic Surgery (cardiothoracic Vascular Surgery) with more than 29 years of experience. He graduated from Albany Medical College Of Union University in 1994. The NPI number of John Goncalves is 1639150949 and was assigned on November 2005. The practitioner's primary taxonomy code is 208G00000X with license number 201051-1 (NY). The provider is registered as an individual and his NPI record was last updated 13 years ago.

NPI
1639150949
Provider Name JOHN J GONCALVES MD
Provider Location Address120 MINEOLA BLVD SUITE 300 MINEOLA, NY 11501
Provider Mailing Address120 MINEOLA BLVD SUITE 300 MINEOLA, NY 11501
GenderMale
NPI Entity TypeIndividual
Medical School NameALBANY MEDICAL COLLEGE OF UNION UNIVERSITY
Graduation Year1994
Is Sole Proprietor?No
Enumeration Date11-14-2005
Last Update Date10-27-2009

John Goncalves 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.

John Goncalves 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 Ns/lij Hs Southside Hospital, North Shore University Hospital and Peconic Bay Medical Center.

The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 95.4, 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 provider also has detailed performance information the following quality measures: chronic care and preventative care management for empaneled patients, clinical data registry reporting, implementation of medication management practice improvements, measurement and improvement at the practice and panel level, provide patients electronic access to their health information, public health registry reporting and security risk analysis.

The typical physician office visit costs for Medicare beneficiaries in this area are: $53.75 for a new patient copayment and $22.04 for an established patient copayment.



Primary Taxonomy

Taxonomy Code208G00000X
ClassificationThoracic Surgery (Cardiothoracic Vascular Surgery)
TypeAllopathic & Osteopathic Physicians
License No.201051-1
License StateNY
Taxonomy DescriptionA thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty.

Business Address

JOHN J GONCALVES MD
120 MINEOLA BLVD
SUITE 300
MINEOLA, NY
ZIP 11501
Phone: (516) 663-4400
Fax: (516) 663-4404

Get Directions


Mailing Address

JOHN J GONCALVES MD
120 MINEOLA BLVD
SUITE 300
MINEOLA, NY
ZIP 11501
Phone: (516) 663-4400
Fax: (516) 663-4404


PECOS Enrollment and Medicare Participation

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 ID5991697476
PECOS Enrollment IDI20040501000008
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 ImagingYes
Eligible order / refer Durable Medical EquipmentYes
Eligible order / refer Home Health Agency (HHA)Yes
Eligible order / refer Power Mobility DevicesYes

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 11501 ZIP code area.

New Patients Office Visits Costs *
Most Utilized Procedure Code for new patients office visits: 99205
Minimum New Patient Pricing Maximum New Patient Pricing Typical New Patient Pricing
$71.49 $215.02 $215.02
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$17.87 $53.75 $53.75
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
$22.05 $174.06 $88.17
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$5.51 $43.51 $22.04

* 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% 100
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 (PI) 25% 77.3
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 15% 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 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 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.
MIPS Final Score - 95.4
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.

MIPS Quality Measures

The following performance measures were reported under the Merit-Based Incentive Payment System (MIPS) and Qualified Clinical Data Registry (QCDR) quality measures program.

Quality Measure Performance Number of Patients
Chronic Care and Preventative Care Management for Empaneled PatientsYesN/A
In order to receive credit for this activity, a MIPS eligible clinician must manage chronic and preventive care for empaneled patients (that is, patients assigned to care teams for the purpose of population health management), which could include one or more of the following actions:-   Provide patients annually with an opportunity for development and/or adjustment of an individualized plan of care as appropriate to age and health status, including health risk appraisal; gender, age and condition-specific preventive care services; and plan of care for chronic conditions;-   Use evidence based, condition-specific pathways for care of chronic conditions (for example, hypertension, diabetes, depression, asthma, and heart failure). These might include, but are not limited to, the NCQA Diabetes Recognition Program (DRP)93 and the NCQA Heart/Stroke Recognition Program (HSRP)94;-   Use pre-visit planning, that is, preparations for conversations or actions to propose with patient before an in-office visit to optimize preventive care and team management of patients with chronic conditions;-   Use panel support tools, (that is, registry functionality) or other technology that can use clinical data to identify trends or data points in patient records to identify services due;-   Use predictive analytical models to predict risk, onset and progression of chronic diseases; and/orUse reminders and outreach (e.g., phone calls, emails, postcards, patient portals, and community health workers where available) to alert and educate patients about services due; and/or routine medication reconciliation.
Clinical Data Registry ReportingYesN/A
The MIPS eligible clinician is in active engagement to submit data to a clinical data registry.
Implementation of medication management practice improvementsYesN/A
Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/orConduct periodic, structured medication reviews.
Measurement and Improvement at the Practice and Panel LevelYesN/A
Measure and improve quality at the practice and panel level, such as the American Board of Orthopaedic Surgery (ABOS) Physician Scorecards, that could include one or more of the following:- Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice level and at the level of the care team or MIPS eligible clinician or group (panel); and/or - Use relevant data sources to create benchmarks and goals for performance at the practice level and panel level.
Provide Patients Electronic Access to Their Health Information 82% 302
For at least one unique patient seen by the MIPS eligible clinician: (1) The patient (or the patient-authorized representative) is provided timely access to view online, download, and transmit his or her health information; and (2) The MIPS eligible clinician ensures the patient's health information is available for the patient (or patient-authorized representative) to access using any application of their choice that is configured to meet the technical specifications of the Application Programing Interface (API) in the MIPS eligible clinician's certified electronic health record technology (CEHRT).
Public Health Registry ReportingYesN/A
The MIPS eligible clinician is in active engagement with a public health agency to submit data to public health registries.
Security Risk AnalysisYesN/A
Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified electronic health record technology (CEHRT) in accordance with requirements in 45 CFR 164.312(a)(2)(iv) and 164.306(d)(3), implement security updates as necessary, and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.

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.

  • 23Replacement of left lower heart chamber valve using artificial valve on heart-lung machine (HCPCS:33405)
  • 22Heart artery bypass to repair one artery (HCPCS:33533)
  • 16Harvest of veins for coronary artery bypass procedure using an endoscope (HCPCS:33508)

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. John Goncalves is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
NS/LIJ HS SOUTHSIDE HOSPITAL301 EAST MAIN STREET
BAY SHORE, NY 11706
(631) 968-3000Acute Care Hospitals330043
NORTH SHORE UNIVERSITY HOSPITAL300 COMMUNITY DRIVE
MANHASSET, NY 11030
(516) 562-0100Acute Care Hospitals330106
PECONIC BAY MEDICAL CENTER1 HEROS WAY
RIVERHEAD, NY 11901
(631) 548-6000Acute Care Hospitals330107

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
I02939MEDICARE UPIN (02)
928761MEDICARE ID-TYPE UNSPECIFIED (04)

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.
1639150949
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
266925098
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 6 + 6 + 9 + 2 + 5 + 0 + 9 + 8 + 24 = 71
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
80 - 71 = 99

The NPI number 1639150949 is valid because the calculated check digit 9 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1609869734 VALERIE CUCCO DO
Individual
Obstetrics & Gynecology120 MINEOLA BLVD SUITE 100
MINEOLA, NY 11501
(516) 663-3010
1487647525 ADAM FLISSER MD
Individual
Obstetrics & Gynecology120 MINEOLA BLVD SUITE 100
MINEOLA, NY 11501
(516) 663-3010
1104819242 FREDRIC MOON DO
Individual
Obstetrics & Gynecology120 MINEOLA BLVD SUITE 100
MINEOLA, NY 11501
(516) 663-3010
1841285152 DIANA HYEJUNG KONG NP
Individual
Nurse Practitioner (Pediatrics)120 MINEOLA BLVD SUITE 210
MINEOLA, NY 11501
(516) 663-4600
1265414791 REESE A WAIN MD
Individual
Surgery (Vascular Surgery)120 MINEOLA BLVD SUITE 300
MINEOLA, NY 11501
(516) 663-4400
1801879648 PATRICE VORWERK M.D.
Individual
Radiology (Diagnostic Radiology)120 MINEOLA BLVD
MINEOLA, NY 11501
(516) 663-4510
1922063841MRS. BARBARA KIMBERLY MOSKOWITZ ANP
Individual
Nurse Practitioner (Adult Health)120 MINEOLA BLVD SUITE 320
MINEOLA, NY 11501
(516) 663-3300
1790741304 CYNTHIA ARLEEN FRETWELL MD
Individual
Obstetrics & Gynecology120 MINEOLA BLVD SUITE 100
MINEOLA, NY 11501
(516) 663-3010
1871543983WINTHROP SURGICAL ASSOCIATES, PC
Organization
Surgery120 MINEOLA BLVD SUITE 320
MINEOLA, NY 11501
(516) 663-3300
1992748677 BARBARA E CROCITTO NP
Individual
Nurse Practitioner120 MINEOLA BLVD STE 10 LOWER LEVEL
MINEOLA, NY 11501
(516) 663-4510
1265475941 SUSANA H FUCHS MD
Individual
Radiology (Diagnostic Radiology)120 MINEOLA BLVD SUITE 10 LOWER LEVEL
MINEOLA, NY 11501
(516) 663-4510
1386688984 TRACY JAE WON LEE MD
Individual
Radiology (Body Imaging)120 MINEOLA BLVD STE 10 LOWER LEVEL
MINEOLA, NY 11501
(516) 663-4510
1073532461 PETER S. FINAMORE MD
Individual
Obstetrics & Gynecology120 MINEOLA BLVD SUITE 100
MINEOLA, NY 11501
(516) 663-3010
1356362685 IGAL FLIGMAN M.D.
Individual
Pediatrics (Pediatric Hematology-Oncology)120 MINEOLA BLVD SUITE 460
MINEOLA, NY 11501
(516) 663-9400
1760403927 LEONARD ROY KRILOV M.D.
Individual
Pediatrics (Pediatric Infectious Diseases)120 MINEOLA BLVD SUITE 210
MINEOLA, NY 11501
(516) 663-9570
1770597817 PHILIP GEORGE SCIMECA M.D.
Individual
Pediatrics (Pediatric Hematology-Oncology)120 MINEOLA BLVD SUITE 460
MINEOLA, NY 11501
(516) 663-9400
1407860570 MARK EFRAIM WEINBLATT M.D.
Individual
Pediatrics (Pediatric Hematology-Oncology)120 MINEOLA BLVD SUITE 460
MINEOLA, NY 11501
(516) 663-9400
1790709970 PAUL JUNG-KOON LEE M.D.
Individual
Pediatrics (Pediatric Infectious Diseases)120 MINEOLA BLVD SUITE 210
MINEOLA, NY 11501
(516) 663-4600
1972519015 NAOMI P. MOSKOWITZ-BROOKS M.D.
Individual
Pediatrics (Pediatric Hematology-Oncology)120 MINEOLA BLVD SUITE 460
MINEOLA, NY 11501
(516) 663-9400
1104901206 ALISHA R OROPALLO M.D.
Individual
Surgery (Vascular Surgery)120 MINEOLA BLVD SUITE 300
MINEOLA, NY 11501
(516) 663-4400

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
John J Goncalves Md is registered as an entity type code: 1. The entity type code describes the type of health care provider that is being assigned an NPI. The entity type codes are:

  • 1 = Person: individual human being who furnishes health care.
  • 2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
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.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.