DR. AMER KHALED ABU ALFA M.D.
NPI 1679697775
Pathology - Anatomic Pathology & Clinical Pathology in Burlington, VT
NPI Status: Active since March 16, 2007
Contact Information
89 BEAUMONT AVE
BURLINGTON, VT
ZIP 05405
Phone: (802) 656-0359
- Individual
- Male
- Years of Experience 37
- Pathology
- Anatomic Pathology & Clinical Pathology
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
About AMER ABU ALFA
This page provides the complete NPI Profile along with additional information for Amer Abu Alfa, a provider established in Burlington, Vermont with a medical specialization in Pathology, focusing in anatomic pathology & clinical pathology and more than 37 years of experience. The healthcare provider is registered in the NPI registry with number 1679697775 assigned on March 2007. The practitioner's primary taxonomy code is 207ZP0102X with license number 042.0014289 (VT). The provider is registered as an individual and his NPI record was last updated 7 years ago.
- NPI
- 1679697775
- Provider Name
- DR. AMER KHALED ABU ALFA M.D.
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 89 BEAUMONT AVE BURLINGTON, VT 05405
- Location Phone
- (802) 656-0359
- Mailing Address
- 60 SUNSET HILL DR MONROE, CT 06468
- Mailing Phone
- (203) 501-3878
- Medical School Name
- OTHER
- Graduation Year
- 1989
- Is Sole Proprietor?
- No
- Enumeration Date
- 03-16-2007
- Last Update Date
- 04-08-2019
- Code Navigator
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
Pathology Anatomic Pathology & Clinical Pathology
- Taxonomy Code
- 207ZP0102X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 042.0014289
- License State
- VT
- Taxonomy Description
- A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.
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 | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | 034925 (CT) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- 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
- Harmony by Medica Bronze $0 Copay PCP Visits - PPO
- Harmony by Medica Bronze $0 Copay PCP Visits + Adult Eye Exam - PPO
- Harmony by Medica Bronze Premier - PPO
- Harmony by Medica Bronze Premier + Adult Eye Exam - PPO
- Harmony by Medica Expanded Bronze Standard - PPO
- Harmony by Medica Expanded Bronze Standard + Adult Eye Exam - PPO
- Harmony by Medica Gold $0 Copay PCP Visits - PPO
- Harmony by Medica Gold $0 Copay PCP Visits + Adult Eye Exam - PPO
- Harmony by Medica Gold Share - PPO
- Harmony by Medica Gold Share + Adult Eye Exam - PPO
- Harmony by Medica Gold Standard - PPO
- Harmony by Medica Gold Standard + Adult Eye Exam - PPO
- Harmony by Medica Silver $0 Copay PCP Visits - PPO
- Harmony by Medica Silver $0 Copay PCP Visits + Adult Eye Exam - PPO
- Harmony by Medica Silver Share - PPO
- Harmony by Medica Silver Share + Adult Eye Exam - PPO
- Harmony by Medica Silver Standard - PPO
- Harmony by Medica Silver Standard + Adult Eye Exam - PPO
- Medica Individual Choice Bronze $0 Copay PCP Visits - HMO
- Medica Individual Choice Bronze HSA - EPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medicare Participation & PECOS Enrollment Status
Amer Abu Alfa 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.
Amer Abu Alfa 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: 6204178171
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: I20190424001217
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.
Pathology examination of tissue using a microscope, high complexity
Pathology examination of tissue using a microscope, intermediate complexity
Pathology examination of tissue using a microscope, moderately high complexity
Pathology examination of tissue using a microscope, moderately low complexity
Special stained specimen slides to examine tissue including interpretation and report
Special stained specimen slides to examine tissue, each additional procedure
Special stained specimen slides to examine tissue, initial procedure
Surgical pathology consultation and report on referred slides prepared elsewhere
A high complexity pathology examination involves studying body tissue under a microscope to identify any abnormalities. This intricate process helps in diagnosing various conditions and deciding on the best treatment plan.
This service was performed 22 times for 22 patientsA pathology examination of tissue with intermediate complexity involves studying a small sample of your body tissue under a microscope. This helps in identifying any abnormal cells or signs of disease. It's a detailed process requiring expert analysis to ensure accurate results.
This service was performed 1,848 times for 815 patientsA pathology examination of tissue with moderate complexity involves a detailed study of a small tissue sample from your body. Using a microscope, experts analyze the tissue's structure and cells to identify any abnormalities. This helps in diagnosing various health conditions accurately.
This service was performed 81 times for 67 patientsA pathology examination of tissue, moderately low complexity, involves studying a small sample of your body tissue under a microscope. It helps to identify any abnormal cells or diseases. It's a routine procedure, not complex, and provides crucial insights for your diagnosis.
This service was performed 90 times for 89 patientsSpecial stained specimen slides are used to examine tissue samples. This involves applying special dyes to the tissue, which helps to highlight certain features under a microscope. The findings are then interpreted and a report is provided. This can aid in diagnosing various health conditions.
This service was performed 21 times for 11 patientsSpecial stained specimen slides are used to analyze tissue in detail. In this process, extra procedures may be needed for a more thorough examination. These involve applying special stains to the tissue on slides, enhancing specific elements for closer study.
This service was performed 141 times for 44 patientsThis procedure involves the use of specially stained slides to examine tissue samples. The initial process involves obtaining a small tissue sample from your body. This sample is then placed on a slide and stained with special dyes to highlight different structures and elements. The stained slide is then examined under a microscope to help diagnose any potential health issues.
This service was performed 72 times for 64 patientsA surgical pathology consultation involves reviewing slides prepared at a different lab to confirm or clarify a diagnosis. It's a second opinion to ensure accuracy. A report with findings and interpretations is then provided for your doctor's reference.
This service was performed 23 times for 23 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $31.92 for a new patient copayment and $24.6 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 05405 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $127.71
- Minimum New Patient Price $55.8
- Maximum New Patient Price $168.48
- Average New Patient Copayment $31.92
- Minimum New Patient Copayment $13.95
- Maximum New Patient Copayment $42.12
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $98.4
- Minimum Established Patient Price $18.08
- Maximum Established Patient Price $137.84
- Average Established Patient Copayment $24.6
- Minimum Established Patient Copayment $4.52
- Maximum Established Patient Copayment $34.46
* 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.
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. Amer Abu Alfa is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| UNIV. OF VERMONT - FLETCHER ALLEN HEALTH CARE | 111 COLCHESTER AVE BURLINGTON, VT 05401 | (802) 847-0000 | Acute Care Hospitals | |
| NORTHEASTERN VERMONT REGIONAL HOSPITAL | 1315 HOSPITAL DRIVE SAINT JOHNSBURY, VT 05819 | (802) 748-7400 | Critical Access Hospitals | |
| NORTH COUNTRY HOSPITAL AND HEALTH CENTER | 189 PROUTY DRIVE NEWPORT, VT 05855 | (802) 334-7331 | Critical Access Hospitals |
Reviews for DR. AMER KHALED ABU ALFA M.D.
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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 1679697775, we treat the final digit (5) 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 75. The final step is to find the difference between that total and the next multiple of ten (80 - 75 = 5).
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 75 is 80. The difference is the calculated check digit.
Other Providers at the Same Location
The following 9 providers are registered at the same or a nearby location.
BURLINGTON, VT 05405
BURLINGTON, VT 05405
BURLINGTON, VT 05405
BURLINGTON, VT 05405
BURLINGTON, VT 05405
BURLINGTON, VT 05405
BURLINGTON, VT 05405
BURLINGTON, VT 05405
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1679697775, enumerated as an "individual" on March 16, 2007.
The provider is located at 89 BEAUMONT AVE BURLINGTON, VT 05405 and the phone number is (802) 656-0359.
Pathology with taxonomy code 207ZP0102X and a focus in Anatomic Pathology & Clinical Pathology.
The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield and Medica. Please consult your insurance carrier or call the provider to verify.
Amer Abu Alfa is affiliated with: UNIV. OF VERMONT - FLETCHER ALLEN HEALTH CARE, NORTHEASTERN VERMONT REGIONAL HOSPITAL and NORTH COUNTRY HOSPITAL AND HEALTH CENTER.
