DR. MICHAEL PETELIS DO NPI 1699861237

Family Medicine in Mineola, NY

NPI 1699861237 Individual Male Years of Experience 26 Family Medicine PECOS Enrolled Accepts Medicare Approved Payment MIPS Quality Score 96 Medicare Quality Reporting

NPI Profile for DR. MICHAEL PETELIS DO

Michael Petelis is a primary care provider established in Mineola, New York and his medical specialization is family medicine with more than 26 years of experience. The NPI number of Michael Petelis is 1699861237 and was assigned on October 2006. The practitioner's primary taxonomy code is 207Q00000X with license number 211294 (NY). The provider is registered as an individual and his NPI record was last updated 13 years ago.

A primary care provider (PCP) like Dr. Michael Petelis Do sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc

Michael Petelis 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.

Michael Petelis 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 North Shore University Hospital and New York University Langone 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 96, 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 following quality measures were reported for this provider: breast cancer screening, colorectal cancer screening, depression screening, diabetes screening, diabetes: eye exam, diabetes: foot exam, diabetes: medical attention for nephropathy, documentation of current medications in the medical record, e-prescribing, falls: screening for future fall risk, immunization registry reporting, medication reconciliation, patient-specific education, pneumococcal vaccination status for older adults, preventive care and screening: body mass index (bmi) screening and follow-up plan, preventive care and screening: influenza immunization, preventive care and screening: screening for depression and follow-up plan, preventive care and screening: tobacco use: screening and cessation intervention, provide patient access, secure messaging, security risk analysis, specialized registry reporting, tobacco use and use of high-risk medications in the elderly.

The typical physician office visit costs for Medicare beneficiaries in this area are: $27.39 for a new patient copayment and $31.16 for an established patient copayment.

NPI

1699861237

Provider NameDR. MICHAEL PETELIS DO
Provider Location Address300 OLD COUNTRY RD SUITE 211 MINEOLA, NY 11501
Provider Mailing Address300 OLD COUNTRY RD SUITE 211 MINEOLA, NY 11501
GenderMale
NPI Entity TypeIndividual
Medical School NameOTHER
Graduation Year1997
Is Sole Proprietor?No
Is Organization Subpart?N/A
Enumeration Date10-04-2006
Last Update Date12-08-2009


Primary Taxonomy

Taxonomy Code207Q00000X
ClassificationFamily Medicine
TypeAllopathic & Osteopathic Physicians
License No.211294
License StateNY
Taxonomy DescriptionFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Business Address

DR. MICHAEL PETELIS DO
300 OLD COUNTRY RD
SUITE 211
MINEOLA, NY
ZIP 11501
Phone: (516) 280-2599
Fax: (516) 280-2597

Get Directions


Mailing Address

DR. MICHAEL PETELIS DO
300 OLD COUNTRY RD
SUITE 211
MINEOLA, NY
ZIP 11501
Phone: (516) 280-2599
Fax: (516) 280-2597



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 ID8325104524
PECOS Enrollment IDI20090312000313
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: 99203
Minimum New Patient Pricing Maximum New Patient Pricing Typical New Patient Pricing
$71.49 $215.02 $109.58
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$17.87 $53.75 $27.39
Established Patients Office Visits Costs *
Most Utilized Procedure Code for established patients office visits: 99214
Minimum Established Patient Pricing Maximum Established Patient Pricing Typical Established Patient Pricing
$22.05 $174.06 $124.65
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$5.51 $43.51 $31.16

* 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% 73
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 - 96
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 Reporting

The following quality measures meet Medicare's statistical reporting standards for the year 2018. 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
Breast Cancer Screening 4% 393
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
Colorectal Cancer Screening 1% 820
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
Depression screeningYesN/A
Depression screening and follow-up plan: Regular engagement of MIPS eligible clinicians or groups in integrated prevention and treatment interventions, including depression screening and follow-up plan (refer to NQF #0418) for patients with co-occurring conditions of behavioral or mental health conditions.
Diabetes screeningYesN/A
Diabetes screening for people with schizophrenia or bipolar disease who are using antipsychotic medication.
Diabetes: Eye Exam 77% 233
Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period
Diabetes: Foot Exam 73% 233
The percentage of patients 18-75 years of age with diabetes (type 1 and type 2) who received a foot exam (visual inspection and sensory exam with mono filament and a pulse exam) during the measurement year
Diabetes: Medical Attention for Nephropathy 84% 233
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 51% 8907
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 96% 10103
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Falls: Screening for Future Fall Risk 85% 377
Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period
Immunization Registry ReportingYesN/A
The MIPS eligible clinician is in active engagement with a public health agency to submit immunization data.
Medication Reconciliation 100% 5017
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 90% 2105
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.
Pneumococcal Vaccination Status for Older Adults 61% 377
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 85% 1782
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 20% 942
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: Screening for Depression and Follow-Up Plan 85% 1857
Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 50% 179
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 Patient Access 29% 2105
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% 2105
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 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 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.
Specialized Registry ReportingYesN/A
The MIPS eligible clinician is in active engagement to submit data to specialized registry. To earn a 5 % bonus in the promoting interoperability performance category score for submitting to one or more public health or clinical data registries also attest to PI_TRANS_PHCDRR_3_MULTI.
Tobacco useYesN/A
Tobacco use: Regular engagement of MIPS eligible clinicians or groups in integrated prevention and treatment interventions, including tobacco use screening and cessation interventions (refer to NQF #0028) for patients with co-occurring conditions of behavioral or mental health and at risk factors for tobacco dependence.
Use of High-Risk Medications in the Elderly 7% "Inverse Quality Measure"
This is an inverse quality measure, a lower rate means the provider is rated better.
377
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

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. Michael Petelis is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
NORTH SHORE UNIVERSITY HOSPITAL300 COMMUNITY DRIVE
MANHASSET, NY 11030
(516) 562-0100Acute Care Hospitals330106
NEW YORK UNIVERSITY LANGONE MEDICAL CENTER550 FIRST AVENUE
NEW YORK, NY 10016
(212) 263-7300Acute Care Hospitals330214

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 Identifier Issuer
A400008184MEDICARE PIN (08)NY
18V841MEDICARE ID-TYPE UNSPECIFIED (04)NY
211294OTHER (01)NYLICENSE
H17815MEDICARE UPIN (02)NY

NPI Validation Check Digit Calculation


The following table explains step by step the 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.
1699861237
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
26189166226
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 6 + 1 + 8 + 9 + 1 + 6 + 6 + 2 + 2 + 6 + 24 = 73
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
80 - 73 = 77

The NPI number 1699861237 is valid because the calculated check digit 7 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
1124026505DR. ROBERT J NEJAT M.D.
Individual
Urology300 OLD COUNTRY RD SUITE 211
MINEOLA, NY 11501
(516) 741-2255
1679560692DR. STEVEN JAY RAVICH MD
Individual
Orthopaedic Surgery300 OLD COUNTRY RD SUITE 151
MINEOLA, NY 11501
(516) 747-5700
1275598575 HUE T. LY M.D.
Individual
Internal Medicine300 OLD COUNTRY RD SUITE 31
MINEOLA, NY 11501
(516) 294-9380
1578516563QUEENS NASSAU NEPHROLOGY SERVICES, P.C.
Organization
Internal Medicine (Nephrology)300 OLD COUNTRY RD SUITE 111
MINEOLA, NY 11501
(516) 745-0500
1306922786DR. R. PHILLIP COLON PH.D.
Individual
Psychologist (Clinical)300 OLD COUNTRY RD SUITE 91
MINEOLA, NY 11501
(516) 294-8914
1780715508MS. IRENE HAJISAVA L.C.S.W.
Individual
Social Worker (Clinical)300 OLD COUNTRY RD SUITE 91
MINEOLA, NY 11501
(516) 294-0411
1841415726 ALLISON ELISE DUBNER PHD
Individual
Psychologist300 OLD COUNTRY RD SUITE 251
MINEOLA, NY 11501
(516) 779-0527
1689894685 IRA J SPECTOR MD
Individual
Obstetrics & Gynecology (Gynecology)300 OLD COUNTRY RD
MINEOLA, NY 11501
(516) 747-4404
1013137017 STEVEN A KLEIN MD
Individual
Obstetrics & Gynecology (Maternal & Fetal Medicine)300 OLD COUNTRY RD
MINEOLA, NY 11501
(516) 747-4404
1588872113NASSAU SPORTS PHYSICAL THERAPY
Organization
Specialist300 OLD COUNTRY RD SUITE 191
MINEOLA, NY 11501
(516) 747-5050
1659516284SAMUEL KENAN,MD.,P.C
Organization
Specialist300 OLD COUNTRY RD SUITE221
MINEOLA, NY 11501
(516) 280-3733
1972839546 JEAN RUVEL MA, RD, CDE, CDN
Individual
Dietitian, Registered300 OLD COUNTRY RD SUITE 202
MINEOLA, NY 11501
(516) 747-4616
1548566342NORTH SHORE RETINA PHYSICIAN, PLLC
Organization
Ophthalmology300 OLD COUNTRY RD SUITE GL 51
MINEOLA, NY 11501
(516) 729-8515
1114925708DR. BINNY KOSHY M.D.
Individual
Internal Medicine (Nephrology)300 OLD COUNTRY RD SUITE 111
MINEOLA, NY 11501
(516) 745-0500
1356349922DR. ANDREY GONCHARUK M.D.
Individual
Internal Medicine (Nephrology)300 OLD COUNTRY RD SUITE 111
MINEOLA, NY 11501
(516) 745-0500
1871591453DR. MARIO MAROTTA M.D.
Individual
Internal Medicine (Nephrology)300 OLD COUNTRY RD SUITE 111
MINEOLA, NY 11501
(516) 745-0500
1598763187DR. YELENA ROSENBERG M.D.
Individual
Internal Medicine (Nephrology)300 OLD COUNTRY RD SUITE 111
MINEOLA, NY 11501
(516) 745-0500
1518965110DR. VINCENT STEVEN AVILA M.D.
Individual
Internal Medicine (Nephrology)300 OLD COUNTRY RD SUITE 111
MINEOLA, NY 11501
(516) 745-0500
1801831763 EDUARD BOVER D.O.
Individual
Internal Medicine (Nephrology)300 OLD COUNTRY RD SUITE 111
MINEOLA, NY 11501
(516) 745-0500
1992703490DR. CHRISTOPHER CAPUTO M.D.
Individual
Internal Medicine (Nephrology)300 OLD COUNTRY RD SUITE 111
MINEOLA, NY 11501
(516) 745-0500

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
Dr. Michael Petelis Do 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.