MICHAEL KEVIN O'BRIEN M.D.
NPI 1730107061
Surgery in New Haven, CT

Medicare Participation & PECOS Enrollment Status

Michael O'brien 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.

Michael O'brien 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: 2365638095

  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: I20101120000112

  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.

Established patient office or other outpatient visit, 10-19 minutes

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

This service was performed 40 times for 30 patients

Established patient office or other outpatient visit, 20-29 minutes

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

This service was performed 52 times for 37 patients

Hernia repair - groin (open)

Hernia repair in the groin area (open) is a surgical procedure to fix a bulge or protrusion, caused by internal tissues pushing through a weak spot in your abdominal wall. In this operation, a small incision is made in the groin area. The protruding tissue is then placed back into the abdomen, and the weakened area is reinforced with stitches or a mesh.

This service was performed for 39 patients

Mastectomy

A mastectomy is a surgical procedure that involves the removal of all or part of the breast tissue. This is often done to treat or prevent conditions related to abnormal cell growth. There are different types, ranging from removing only the breast tissue to also removing nearby structures. The approach depends on individual health circumstances.

This service was performed for 1-10 patients

New patient office or other outpatient visit, 15-29 minutes

This service involves an initial visit to the doctor's office or other outpatient setting. It typically lasts between 15-29 minutes. The doctor will review your medical history, conduct a physical examination, and discuss your health concerns. It's a chance to establish your health baseline and address any immediate medical issues.

This service was performed 13 times for 13 patients

New patient office or other outpatient visit, 30-44 minutes

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

This service was performed 50 times for 50 patients

Repair of groin hernia (5 years or older)

Repair of a groin hernia is a procedure aimed at fixing an abnormal bulge that can occur in the area between your abdomen and thigh. This condition happens when tissue pushes through a weak spot in your lower abdominal wall. The repair procedure returns this tissue back to its proper place.

This service was performed 14 times for 14 patients

Simple or single drainage of skin abscess

A simple or single drainage of skin abscess is a procedure to remove pus from a skin infection. A small cut is made on the abscess, the pus is drained out, and the area is cleaned. This helps to reduce pain, speed up recovery, and prevent the spread of infection.

This service was performed 11 times for 11 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $23.46 for a new patient copayment and $18.88 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 06510 ZIP code area.

* 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.

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