NINA KARLSEN AYALA MD
NPI 1669899522
Obstetrics & Gynecology - Maternal & Fetal Medicine in Providence, RI

NPI Status: Active since March 27, 2014

Contact Information

101 PLAIN ST FL 6
PROVIDENCE, RI
ZIP 02903
Phone: (401) 274-1122

NPI Profile Information
Primary Taxonomy
Secondary Taxonomies
Insurance Plans Accepted
Secondary Locations
Medicare Participation & PECOS Status
Physician Visit Costs
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Female
Years of Experience 12
Obstetrics & Gynecology
Maternal & Fetal Medicine
Accepts Insurance
Accepts Medicare Approved Payment
PECOS Enrolled

About NINA AYALA

This page provides the complete NPI Profile along with additional information for Nina Ayala, a women's health care provider established in Providence, Rhode Island with a medical specialization in Obstetrics & Gynecology, focusing in maternal & fetal medicine and more than 12 years of experience. The healthcare provider is registered in the NPI registry with number 1669899522 assigned on March 2014. The practitioner's primary taxonomy code is 207VM0101X with license number MD16234 (RI). The provider is registered as an individual and her NPI record was last updated 2 years ago.

NPI: 1669899522
Provider Name: NINA KARLSEN AYALA MD
Other Name: NINA TEREZ KARLSEN-AYALA
Other Name Type: Former Name (1)
Gender: Female
Entity Type: Individual
Location Address: 101 PLAIN ST FL 6 PROVIDENCE, RI 02903
Location Phone: (401) 274-1122
Mailing Address: 455 TOLL GATE RD WARWICK, RI 02886
Mailing Phone: (401) 273-0641
Medical School Name: OTHER
Graduation Year: 2014
Is Sole Proprietor?: Yes
Enumeration Date: 03-27-2014
Last Update Date: 07-09-2024
Code Navigator

Women's health care providers like Nina Ayala treat and diagnose diseases and conditions that affect a woman's physical and emotional health. Women's health professionals come from a variety of different specialties, including obstetrician/gynecologists, general surgeons, perinatologists, physician assistants, nurse practitioners or nurse midwives. A women's health provider might help you with family planning, breast care, pregnancy and child birth, osteoporosis, menopause, heart disease, etc.

Location Map

Secondary Locations

101 Dudley St
Providence, RI 02905
(401) 274-1100
300A Faunce Corner Rd Ste 202
North Dartmouth, MA 02747
(508) 995-2762

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: Obstetrics & Gynecology Maternal & Fetal Medicine
Taxonomy Code: 207VM0101X
Type: Allopathic & Osteopathic Physicians
License No.: MD16234
License State: RI
Taxonomy Description: An obstetrician/gynecologist who cares for, or provides consultation on, patients with complications of pregnancy. This specialist has advanced knowledge of the obstetrical, medical and surgical complications of pregnancy and their effect on both the mother and the fetus. The specialist also possesses expertise in the most current diagnostic and treatment modalities used in the care of patients with complicated pregnancies.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No.	Taxonomy Code	Type	Classification / Specialization	License No. (State)
1	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology	MD16234 (RI)

Insurance Plans Accepted

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

Anthem Blue Cross and Blue Shield

Anthem Bronze Access Blue New England HMO 6000/20%/8000 w/HSA - HMO
Anthem Bronze Access Blue New England HMO 7000/50%/8000 w/HSA - HMO
Anthem Bronze Access Blue New England HMO 7500/30%/10000 Value - HMO
Anthem Bronze Access Blue New England HMO 8500/50%/9200 - HMO
Anthem Gold Access Blue New England HMO 1000/20%/7500 - HMO
Anthem Gold Access Blue New England HMO 2000/0%/6500 RxD - HMO
Anthem Gold Access Blue New England HMO 2000/10%/4600 w/HSA - HMO
Anthem Gold Access Blue New England HMO 2000/10%/7500 - HMO
Anthem Gold Access Blue New England HMO 2000/20%/4600 w/HSA - HMO
Anthem Gold Access Blue New England HMO 3000/0%/7500 RxD - HMO
Anthem Gold Access Blue New England HMO 500/30%/9000 - HMO
Anthem Platinum Access Blue New England HMO 250/10%/3500 - HMO
Anthem Silver Access Blue New England HMO 2500/30%/10000 Value - HMO
Anthem Silver Access Blue New England HMO 3000/30%/9000 Value - HMO
Anthem Silver Access Blue New England HMO 3500/20%/10000 - HMO
Anthem Silver Access Blue New England HMO 3500/20%/7250 w/HSA - HMO
Anthem Silver Access Blue New England HMO 4000/0%/9000 - HMO
Anthem Silver Access Blue New England HMO 4000/0%/9000 RxD - HMO
Anthem Silver Access Blue New England HMO 4000/10%/7250 w/HSA - HMO
Anthem Silver Access Blue New England HMO 4000/20%/8500 - HMO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Medicare Participation & PECOS Enrollment Status

Nina Ayala 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.

Nina Ayala 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: 9133418270
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: I20180605002695, I20210720000223
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

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $33.54 for a new patient copayment and $18.23 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 02903 ZIP code area.

New Patients Visit Costs *

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

Average New Patient Price $134.17
Minimum New Patient Price $58.57
Maximum New Patient Price $177.03

Average New Patient Copayment $33.54
Minimum New Patient Copayment $14.64
Maximum New Patient Copayment $44.25

Established Patients Visit Costs *

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

Average Established Patient Price $72.93
Minimum Established Patient Price $18.92
Maximum Established Patient Price $144.38

Average Established Patient Copayment $18.23
Minimum Established Patient Copayment $4.73
Maximum Established Patient Copayment $36.09

* 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.

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 1669899522, we treat the final digit (2) 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 78. The final step is to find the difference between that total and the next multiple of ten (80 - 78 = 2).

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.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 12 → 1 + 2

Pos 4

Unchanged

Pos 5

Doubled → 16 → 1 + 6

Pos 6

Unchanged

Pos 7

Doubled → 18 → 1 + 8

Pos 8

Unchanged

Pos 9

Doubled → 4

Check

Target digit

Regular digit Doubled digit Check digit

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.

1 → 2 6 → 12 → 3 8 → 16 → 7 9 → 18 → 9 2 → 4

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 6 + 1 + 2 + 9 + 1 + 6 + 9 + 1 + 8 + 5 + 4 + 24 = 78

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 78 is 80. The difference is the calculated check digit.

80 - 78 = 2

This NPI is valid

The calculated check digit is 2, which matches the last digit of 1669899522.