DR. SHIRA SIVAN SIMON M.D., M.B.A.
NPI 1659632420
Ophthalmology in Chicago, IL
About Dr. Shira Sivan Simon M.d., M.b.a. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. SHIRA SIVAN SIMON M.D., M.B.A. (NPI 1659632420) is an individual ophthalmology provider in Chicago, Illinois, licensed in Illinois (036.144693) and active in the NPI registry since June 2012. She is enrolled in Medicare PECOS, is affiliated with Northwestern Lake Forest Hospital, and maintains a secondary practice location in Iowa City.
NPPES Registry Identity
Specialties & Licenses 2
An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dr. Shira Sivan Simon M.d., M.b.a. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
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 office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more
Exam of visual field with extended testing
Imaging of optic nerve
New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more
Photography of the retina
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
This service was performed 247 times for 182 patientsAn extended visual field exam is a detailed test to evaluate your peripheral (side) vision. It helps to detect any potential blind spots which may not be noticeable in daily life. These could be caused by eye diseases like glaucoma, or neurological conditions.
This service was performed 213 times for 162 patientsImaging of the optic nerve is a non-invasive procedure that captures detailed pictures of your optic nerve. It helps doctors assess eye health, particularly for conditions like glaucoma. It's painless, quick, and uses safe technology like MRI or OCT (Optical Coherence Tomography).
This service was performed 192 times for 146 patientsThis is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.
This service was performed 44 times for 44 patientsPhotography of the retina, also known as retinal imaging, is a non-invasive procedure that captures images of the back of your eye. This helps doctors identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. It's painless and quick, often part of a routine eye exam.
This service was performed 14 times for 14 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $34.71 for a new patient copayment and $18.7 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 60611 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $138.86
- Minimum New Patient Price $60.08
- Maximum New Patient Price $183.39
- Average New Patient Copayment $34.71
- Minimum New Patient Copayment $15.02
- Maximum New Patient Copayment $45.84
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $74.8
- Minimum Established Patient Price $18.97
- Maximum Established Patient Price $148.12
- Average Established Patient Copayment $18.7
- Minimum Established Patient Copayment $4.74
- Maximum Established Patient Copayment $37.03
* 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 94.1, 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.
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Final Score: 94.1 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.
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Quality Score: 82.59
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 comprises 40% of a provider's final MIPS score.
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.
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Promoting Interoperability Score: 100
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 comprises 25% of a provider's final MIPS score.
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 comprises 15% of a provider's final MIPS score.
The Improvement measures aim to better patient engagement, patient safety and other areas of patient care. The Improvement Activities category comprises 15% of a provider's final MIPS score. -
Cost Score: N/A
The Cost performance category assesses 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 comprises 20% of a provider's final MIPS score.
Find Provider Hospital Affiliations - Privileges
Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.
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. Shira Simon is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| NORTHWESTERN LAKE FOREST HOSPITAL | 1000 N WESTMORELAND ROAD LAKE FOREST, IL 60045 | (847) 234-5600 | Acute Care Hospitals | |
| NORTHWESTERN MEMORIAL HOSPITAL | 251 E HURON ST CHICAGO, IL 60611 | (312) 926-2000 | Acute Care Hospitals |
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
CHICAGO, IL 60611
CHICAGO, IL 60611
CHICAGO, IL 60611
CHICAGO, IL 60611
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1659632420, enumerated as an "individual" on June 07, 2012.
The provider is located at 259 E ERIE ST CHICAGO, IL 60611 and the phone number is (312) 695-6868.
Ophthalmology with taxonomy code 207W00000X.
Shira Simon is affiliated with: NORTHWESTERN LAKE FOREST HOSPITAL and NORTHWESTERN MEMORIAL HOSPITAL.
