THOMAS HILTON CAWTHON JR. M.D.
NPI 1659337574
Internal Medicine - Cardiovascular Disease in Birmingham, AL

Quality Rating: 86.55 out of 100 score

NPI Status: Active since April 21, 2006

Contact Information

801 PRINCETON AVE SW
SUITE 707
BIRMINGHAM, AL
ZIP 35211
Phone: (205) 780-4330
Fax: (205) 780-7775

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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
Quality Reporting
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Male
Years of Experience 30
Internal Medicine
Cardiovascular Disease
Accepts Insurance
Accepts Medicare Approved Payment
PECOS Enrolled
Medicare Quality Reporting

About THOMAS CAWTHON

This page provides the complete NPI Profile along with additional information for Thomas Cawthon, an internist established in Birmingham, Alabama with a medical specialization in Internal Medicine, focusing in cardiovascular disease and more than 30 years of experience. He graduated from Tulane University School Of Medicine in 1996. The healthcare provider is registered in the NPI registry with number 1659337574 assigned on April 2006. The practitioner's primary taxonomy code is 207RC0000X with license number 00021298 (AL). The provider is registered as an individual and his NPI record was last updated 13 years ago.

NPI: 1659337574
Provider Name: THOMAS HILTON CAWTHON JR. M.D.
Gender: Male
Entity Type: Individual
Location Address: 801 PRINCETON AVE SW SUITE 707 BIRMINGHAM, AL 35211
Location Phone: (205) 780-4330
Location Fax: (205) 780-7775
Mailing Address: 801 PRINCETON AVE SW SUITE 707 BIRMINGHAM, AL 35211
Mailing Phone: (205) 780-4330
Mailing Fax: (205) 780-7775
Medical School Name: TULANE UNIVERSITY SCHOOL OF MEDICINE
Graduation Year: 1996
Is Sole Proprietor?: No
Enumeration Date: 04-21-2006
Last Update Date: 08-08-2012
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An internist like Thomas Cawthon is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, 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: Internal Medicine Cardiovascular Disease
Taxonomy Code: 207RC0000X
Type: Allopathic & Osteopathic Physicians
License No.: 00021298
License State: AL
Taxonomy Description: An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

Insurance Plans Accepted

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

Blue Cross and Blue Shield of Alabama

Blue HSA Bronze - PPO
Blue Protect - PPO
Blue Saver Bronze - PPO
Blue Saver Silver EPO - EPO
Blue Standardized Silver EPO - EPO
Blue Value Gold - PPO
Blue Value Silver - PPO
Blue Access Gold for Business - PPO
Blue Choice Platinum for Business - PPO
Blue HSA Silver for Business - PPO
Blue Saver Bronze for Business - PPO
Blue Saver Gold for Business - PPO
Blue Secure Gold for Business - PPO
Blue Secure Silver for Business - PPO

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
051553625	MEDICARE ID-TYPE UNSPECIFIED (04)	AL
G90343	MEDICARE UPIN (02)	AL
051553625	MEDICAID (05)	AL

Medicare Participation & PECOS Enrollment Status

Thomas Cawthon 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.

Thomas Cawthon 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: 9830282011
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: I20100720000467
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.

Coronary angioplasty and stenting
Electrocardiogram (ecg) up to 30 days continuous with review and report by health care professional
Established patient office or other outpatient visit, 10-19 minutes
Established patient office or other outpatient visit, 30-39 minutes
Evaluation of single, dual, multiple lead or leadless pacemaker system or implantable defibrillator system, remote up to 90 days
Evaluation of single, dual, multiple lead or leadless pacemaker system, remote up to 90 days
Evaluation of single, dual, or multiple lead implantable defibrillator system, remote up to 90 days
Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision and review by physician
Follow-up hospital inpatient care per day, typically 35 minutes
Hospital discharge day management, 30 minutes or less
Initial hospital inpatient care per day, typically 70 minutes
Injection of drug or substance into vein
Injection, regadenoson, 0.1 mg
Insertion of stents with balloon dilation of coronary artery or branch, single artery or branch
Insertion of tube in left lower heart chamber and coronary artery for diagnosis with review by radiologist
Insertion of tube in left lower heart chamber, coronary artery and bypass graft for diagnosis with review by radiologist
New patient office or other outpatient visit, 45-59 minutes
Nuclear medicine studies of blood flow in heart muscle at rest and with stress with concurrent ct scan
Nuclear medicine studies of heart muscle at rest and with stress and spect
Pacemaker insertion or repair
Programming of dual lead pacemaker system
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report
Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries
Smoking and tobacco use intensive counseling, 4-10 minutes
Technetium tc-99m tetrofosmin, diagnostic, per study dose
Telephone medical discussion with physician, 5-10 minutes
Thallium tl-201 thallous chloride, diagnostic, per millicurie
Transitional care management services for problem of moderate complexity
Ultrasound of both sides of head and neck blood flow
Ultrasound of heart with color-depicted blood flow, rate, direction and valve function
Ultrasound of heart with color-depicted blood flow, rate, direction and valve function
Ultrasound of heart, follow-up
Ultrasound study of arm and leg arteries
Use of a drug to induce depression of consciousness by physician performing a procedure (5 years or older), initial 15 minutes

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $30.57 for a new patient copayment and $16.52 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 35211 ZIP code area.

New Patients Visit Costs *

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

Average New Patient Price $122.31
Minimum New Patient Price $52.65
Maximum New Patient Price $161.63

Average New Patient Copayment $30.57
Minimum New Patient Copayment $13.16
Maximum New Patient Copayment $40.4

Established Patients Visit Costs *

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

Average Established Patient Price $66.08
Minimum Established Patient Price $16.56
Maximum Established Patient Price $131.65

Average Established Patient Copayment $16.52
Minimum Established Patient Copayment $4.14
Maximum Established Patient Copayment $32.91

* 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 86.55, 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: 86.55 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: 93.31

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: N/A

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: 58.07

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: 58.07

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.

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	28%	1181
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
Diabetes: Medical Attention for Nephropathy	91%	419
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
Documentation of Current Medications in the Medical Record	99%	3197
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration
e-Prescribing	93%	6010
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Medication Reconciliation	92%	396
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
Patient-Specific Education	100%	2074
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan	90%	1871
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: Influenza Immunization	71%	1162
Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	74%	90
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Provide 24/7 Access to MIPS Eligible Clinicians or Groups Who Have Real-Time Access to Patient's Medical Record	Yes	N/A
• Provide 24/7 access to MIPS eligible clinicians, groups, or care teams for advice about urgent and emergent care (e.g., MIPS eligible clinician and care team access to medical record, cross-coverage with access to medical record, or protocol-driven nurse line with access to medical record) that could include one or more of the following: • Expanded hours in evenings and weekends with access to the patient medical record (e.g., coordinate with small practices to provide alternate hour office visits and urgent care); • Use of alternatives to increase access to care team by MIPS eligible clinicians and groups, such as e-visits, phone visits, group visits, home visits and alternate locations (e.g., senior centers and assisted living centers); and/or Provision of same-day or next-day access to a consistent MIPS eligible clinician, group or care team when needed for urgent care or transition management.
Provide Patient Access	97%	2074
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information.
Secure Messaging	2%	2074
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period.
Security Risk Analysis	Yes	N/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 EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.
Statin Therapy for the Prevention and Treatment of Cardiovascular Disease	89%	1443
Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period: - Adults aged >= 21 years who were previously diagnosed with or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD); OR - Adults aged >=21 years who have ever had a fasting or direct low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL; OR - Adults aged 40-75 years with a diagnosis of diabetes with a fasting or direct LDL-C level of 70-189 mg/dL
Use of High-Risk Medications in the Elderly	0% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better.	1179
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication. 2) Percentage of patients who were ordered at least two of the same high-risk medication

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	5	9	3	3	7	5	7	4
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	6	10	9	6	3	14	5	14
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 6 + 1 + 0 + 9 + 6 + 3 + 1 + 4 + 5 + 1 + 4 + 24 = 66
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 66 = 4									4

The NPI number 1659337574 is valid because the calculated check digit 4 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.

ELIAS CALVIN WATSON III MD

Dermatology

801 PRINCETON AVE SW
SUITE 520
BIRMINGHAM, AL
ZIP 35211

About THOMAS CAWTHON

Location Map

Specialty - Primary Taxonomy

Internal Medicine Cardiovascular Disease

Insurance Plans Accepted

Blue Cross and Blue Shield of Alabama

Medicare

Medicaid

Additional Identifiers

Medicare Participation & PECOS Enrollment Status

Is the provider registered in PECOS? Yes

PECOS PAC ID: 9830282011

PECOS Enrollment ID: I20100720000467

Accepts Medicare Assignment? 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

Areas of Expertise

Coronary angioplasty and stenting

Electrocardiogram (ecg) up to 30 days continuous with review and report by health care professional

Established patient office or other outpatient visit, 10-19 minutes

Established patient office or other outpatient visit, 30-39 minutes

Evaluation of single, dual, multiple lead or leadless pacemaker system or implantable defibrillator system, remote up to 90 days

Evaluation of single, dual, multiple lead or leadless pacemaker system, remote up to 90 days

Evaluation of single, dual, or multiple lead implantable defibrillator system, remote up to 90 days

Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision and review by physician

Follow-up hospital inpatient care per day, typically 35 minutes

Hospital discharge day management, 30 minutes or less

Initial hospital inpatient care per day, typically 70 minutes

Injection of drug or substance into vein

Injection, regadenoson, 0.1 mg

Insertion of stents with balloon dilation of coronary artery or branch, single artery or branch

Insertion of tube in left lower heart chamber and coronary artery for diagnosis with review by radiologist

Insertion of tube in left lower heart chamber, coronary artery and bypass graft for diagnosis with review by radiologist

New patient office or other outpatient visit, 45-59 minutes

Nuclear medicine studies of blood flow in heart muscle at rest and with stress with concurrent ct scan

Nuclear medicine studies of heart muscle at rest and with stress and spect

Pacemaker insertion or repair

Programming of dual lead pacemaker system

Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report

Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries

Smoking and tobacco use intensive counseling, 4-10 minutes

Technetium tc-99m tetrofosmin, diagnostic, per study dose

Telephone medical discussion with physician, 5-10 minutes

Thallium tl-201 thallous chloride, diagnostic, per millicurie

Transitional care management services for problem of moderate complexity

Ultrasound of both sides of head and neck blood flow

Ultrasound of heart with color-depicted blood flow, rate, direction and valve function

Ultrasound of heart with color-depicted blood flow, rate, direction and valve function

Ultrasound of heart, follow-up

Ultrasound study of arm and leg arteries

Use of a drug to induce depression of consciousness by physician performing a procedure (5 years or older), initial 15 minutes

Physician Visit Costs

New Patients Visit Costs *

Established Patients Visit Costs *

Overall MIPS Quality Performance

Final Score: 86.55 out of 100

Quality Score: 93.31

Promoting Interoperability Score: N/A

Improvement Activities Score: 40

Cost Score: 58.07

Cost Score: 58.07

Quality Reporting

Reviews for THOMAS HILTON CAWTHON JR. M.D.

NPI Validation Check Digit Calculation

Other Providers at the Same Location

Frequently Asked Questions

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