DR. HEATHER LEE BABE M.D. NPI 1710917026

Family Medicine in Shenandoah, IA

NPI 1710917026 Individual Female Years of Experience 18 Family Medicine PECOS Enrolled Accepts Medicare Approved Payment MIPS Quality Score 94

NPI Profile for DR. HEATHER LEE BABE M.D.

Heather Babe is a primary care provider established in Shenandoah, Iowa and her medical specialization is family medicine with more than 18 years of experience. She graduated from Creighton University School Of Medicine in 2005. The NPI number of Heather Babe is 1710917026 and was assigned on July 2006. The practitioner's primary taxonomy code is 207Q00000X with license number 36911 (IA). The provider is registered as an individual and her NPI record was last updated 8 years ago.

A primary care provider (PCP) like Dr. Heather Lee Babe M.d. 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

Heather Babe 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.

Heather Babe 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 she has hospital affiliations with Shenandoah Medical Center and Clarinda Regional Health 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 94, 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 typical physician office visit costs for Medicare beneficiaries in this area are: $21.16 for a new patient copayment and $24.57 for an established patient copayment.

NPI

1710917026

Provider NameDR. HEATHER LEE BABE M.D.
Provider Location Address1 JACK FOSTER DR SHENANDOAH, IA 51601
Provider Mailing Address300 PERSHING AVE SHENANDOAH, IA 51601
GenderFemale
NPI Entity TypeIndividual
Medical School NameCREIGHTON UNIVERSITY SCHOOL OF MEDICINE
Graduation Year2005
Is Sole Proprietor?No
Is Organization Subpart?N/A
Enumeration Date07-03-2006
Last Update Date05-28-2014


Primary Taxonomy

Taxonomy Code207Q00000X
ClassificationFamily Medicine
TypeAllopathic & Osteopathic Physicians
License No.36911
License StateIA
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. HEATHER LEE BABE M.D.
1 JACK FOSTER DR
SHENANDOAH, IA
ZIP 51601
Phone: (712) 246-7400

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Mailing Address

DR. HEATHER LEE BABE M.D.
300 PERSHING AVE
SHENANDOAH, IA
ZIP 51601
Phone: (712) 246-1230



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 ID4385640010
PECOS Enrollment IDI20080116000043
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 51601 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
$54.88 $167.71 $84.67
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$13.72 $41.92 $21.16
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
$17.04 $137.36 $98.29
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$4.26 $34.34 $24.57

* 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% 71.3
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 - 94
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.

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. Heather Babe is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
SHENANDOAH MEDICAL CENTER300 PERSHING AVENUE
SHENANDOAH, IA 51601
(712) 246-1230Critical Access Hospitals161366
CLARINDA REGIONAL HEALTH CENTER220 ESSIE DAVISON DRIVE
CLARINDA, IA 51632
(712) 542-2176Critical Access Hospitals161352

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine23772NENo

Taxonomy Description: family 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.

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.
1710917026
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
27201811404
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 7 + 2 + 0 + 1 + 8 + 1 + 1 + 4 + 0 + 4 + 24 = 54
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 54 = 66

The NPI number 1710917026 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the same location


The following 15 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1427300201SHENANDOAH MEDICAL CENTER
Organization
Clinic/Center (Rural Health)1 JACK FOSTER DR
SHENANDOAH, IA 51601
(712) 246-7240
1174537567 SATYA S THIPPAREDDI MD
Individual
Family Medicine1 JACK FOSTER DR
SHENANDOAH, IA 51601
(712) 246-7400
1184033300SHENANDOAH MEDICAL CENTER
Organization
Nurse Practitioner1 JACK FOSTER DR
SHENANDOAH, IA 51601
(712) 246-7400
1730172040 PAUL ANDREW ROZEBOOM M.D.
Individual
Pediatrics (Adolescent Medicine)1 JACK FOSTER DR
SHENANDOAH, IA 51601
(712) 246-7400
1821059510DR. BRIAN ANTHONY ROWAN MD
Individual
Orthopaedic Surgery1 JACK FOSTER DR
SHENANDOAH, IA 51601
(712) 246-7400
1770718660DR. MICHAEL THEODORE SALWITZ MD
Individual
Family Medicine1 JACK FOSTER DR
SHENANDOAH, IA 51601
(712) 246-7400
1295761856NEBRASKA MEDICAL CENTER
Organization
Family Medicine1 JACK FOSTER DR
SHENANDOAH, IA 51601
(712) 246-7400
1376037770 STEPHANIE ROBINETTE ARNP
Individual
Nurse Practitioner (Family)1 JACK FOSTER DR
SHENANDOAH, IA 51601
(712) 246-7400
1336567825 TIMOTHY JOSEPH SMITH M.D.
Individual
Internal Medicine1 JACK FOSTER DR
SHENANDOAH, IA 51601
(712) 246-7400
1841260346SHENANDOAH DOCTORS CLINIC
Organization
Clinic/Center1 JACK FOSTER DR SUITE #447
SHENANDOAH, IA 51601
(712) 246-1000
1396189007MRS. MELISSA MARIE HOBBIE LMSW
Individual
Counselor (Mental Health)1 JACK FOSTER DR
SHENANDOAH, IA 51601
(712) 246-7423
1003027939DR. TODD MIKAEL ISAACSON M.D.
Individual
Family Medicine1 JACK FOSTER DR
SHENANDOAH, IA 51601
(712) 246-7400
1245404086 MARTEE R MACLEOD-KOZAL M.D.
Individual
Obstetrics & Gynecology1 JACK FOSTER DR
SHENANDOAH, IA 51601
(712) 246-7054
1518055847 DONALD L BUMGARNER M.D.
Individual
Family Medicine1 JACK FOSTER DR
SHENANDOAH, IA 51601
(712) 246-7400
1609015577DR. REBECCA JUDENE ROSE MD
Individual
Surgery1 JACK FOSTER DR
SHENANDOAH, IA 51601
(712) 246-7485

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. Heather Lee Babe M.d. 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.