BRIAN JAY SHIMKUS MD NPI 1730164591
Internal Medicine - Hematology & Oncology in Austin, TX
About BRIAN JAY SHIMKUS MD
Brian Shimkus is an internist established in Austin, Texas and his medical specialization is Internal Medicine with a focus in hematology & oncology with more than 25 years of experience. He graduated from Medical College Of Georgia School Of Medicine in 1998. The NPI number of this provider is 1730164591 and was assigned on December 2005. The practitioner's primary taxonomy code is 207RH0003X with license number L5907 (TX). The provider is registered as an individual and his NPI record was last updated 7 years ago.
| NPI | 1730164591 |
| Provider Name | BRIAN JAY SHIMKUS MD |
| Location Address | 11111 RESEARCH BLVD STE. 450 AUSTIN, TX 78759 |
| Location Phone | (512) 334-2103 |
| Mailing Address | 11111 RESEARCH BLVD 450 AUSTIN, TX 78759 |
| Gender | Male |
| NPI Entity Type | Individual |
| Medical School Name | MEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE |
| Graduation Year | 1998 |
| Is Sole Proprietor? | No |
| Enumeration Date | 12-14-2005 |
| Last Update Date | 11-18-2015 |
An internist like Brian Shimkus is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.Brian Shimkus 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.
Brian Shimkus 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 .
The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 45, 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 provider also has detailed performance information the following quality measures: closing the referral loop: receipt of specialist report, documentation of current medications in the medical record, falls: screening for future fall risk, oncology: medical and radiation - pain intensity quantified, 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: tobacco use: screening and cessation intervention and use of high-risk medications in the elderly.
The typical physician office visit costs for Medicare beneficiaries in this area are: $44.95 for a new patient copayment and $26.49 for an established patient copayment.
Primary Taxonomy
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.
| Taxonomy Code | 207RH0003X |
| Classification | Internal Medicine |
| Type | Allopathic & Osteopathic Physicians |
| Specialization | Hematology & Oncology |
| License No. | L5907 |
| License State | TX |
| Taxonomy Description | An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
Accepted Insurance
The NPI profile data indicates this provider might be enrolled and accepting health plans from the following insurance companies or healthcare programs:
- Medicaid
- Medicare
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Business Address
11111 RESEARCH BLVD
STE. 450
AUSTIN, TX
ZIP 78759
Phone: (512) 334-2103
Fax: (512) 334-2804
Mailing Address
11111 RESEARCH BLVD
450
AUSTIN, TX
ZIP 78759
Phone: (512) 334-2103
Fax: (512) 334-2804
Location Map
PECOS Enrollment and Medicare Participation Status
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 ID | 3779506894 |
| PECOS Enrollment ID | I20091015000103 |
| 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 Imaging | Yes |
| Eligible order / refer Durable Medical Equipment | Yes |
| Eligible order / refer Home Health Agency (HHA) | Yes |
| Eligible order / refer Power Mobility Devices | Yes |
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 78759 ZIP code area.
| New Patients Office Visits Costs * | ||
|---|---|---|
| Most Utilized Procedure Code for new patients office visits: 99205 | ||
| Minimum New Patient Pricing | Maximum New Patient Pricing | Typical New Patient Pricing |
| $59.83 | $179.81 | $179.81 |
| Minimum New Patient Copayment | Maximum New Patient Copayment | Typical New Patient Copayment |
| $14.95 | $44.95 | $44.95 |
| 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 |
| $19.07 | $147.53 | $105.96 |
| Minimum Established Patient Copayment | Maximum Established Patient Copayment | Typical Established Patient Copayment |
| $4.76 | $36.88 | $26.49 |
* 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% | N/A | |
|
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. |
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| Promoting Interoperability (PI) | 25% | N/A | |
|
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. |
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| Improvement Activities | 15% | N/A | |
|
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. |
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| 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. |
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| MIPS Final Score | - | 45 | |
| 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. | |||
MIPS Quality Measures
The following performance measures were reported under the Merit-Based Incentive Payment System (MIPS) and Qualified Clinical Data Registry (QCDR) quality measures program.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Closing the Referral Loop: Receipt of Specialist Report | 39% | 108 |
| Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred. | ||
| Documentation of Current Medications in the Medical Record | 88% | 3903 |
| Percentage of visits for patients aged 18 years and older for which the MIPS 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. | ||
| Falls: Screening for Future Fall Risk | 0% | 729 |
| Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period. | ||
| Oncology: Medical and Radiation - Pain Intensity Quantified | 99% | 915 |
| Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified. | ||
| Pneumococcal Vaccination Status for Older Adults | 10% | 729 |
| 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 | 50% | 706 |
| 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. | ||
| Preventive Care and Screening: Influenza Immunization | 17% | 1170 |
| 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: Tobacco Use: Screening and Cessation Intervention | 46% | 26 |
| 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 usera. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months.b. Percentage of patients aged 18 years and older who were identified as a tobacco user who received tobacco cessation intervention.c. 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. | ||
| Use of High-Risk Medications in the Elderly | 22% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better. | 729 |
| 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 medications. | ||
Clinician Utilization
The following Healthcare Common Procedure Coding System (HCPCS) codes were publicly reported as the top services rendered by this provider under the Medicare program for the year 2017. The reported codes are based on the top 5 codes for each available Medicare specialty, excluding evaluation and management codes.
- 3494Injection, dexamethasone sodium phosphate, 1mg (HCPCS:J1100)
- 2617Complete blood cell count (red cells, white blood cell, platelets), automated test (HCPCS:85025)
- 945Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour (HCPCS:96367)
- 815Injection beneath the skin or into muscle for therapy, diagnosis, or prevention (HCPCS:96372)
- 711Infusion of chemotherapy into a vein up to 1 hour (HCPCS:96413)
- 700Insertion of needle into vein for collection of blood sample (HCPCS:36415)
- 336Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour (HCPCS:96365)
- 106Urinalysis, manual test (HCPCS:81002)
- 39Nuclear medicine study with CT imaging skull base to mid-thigh (HCPCS:78815)
- 24Administration of influenza virus vaccine (HCPCS:G0008)
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 |
|---|---|---|
| 157781901 | MEDICAID (05) | TX |
| 27219YN57 | MEDICARE PIN (08) | TX |
| 272191YN56 | MEDICARE PIN (08) | TX |
NPI Validation Check Digit Calculation
The following table explains the step by step 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. | |||||||||
| 1 | 7 | 3 | 0 | 1 | 6 | 4 | 5 | 9 | 1 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 7 | 6 | 0 | 2 | 6 | 8 | 5 | 18 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 7 + 6 + 0 + 2 + 6 + 8 + 5 + 1 + 8 + 24 = 69 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 69 = 1 | 1 | ||||||||
The NPI number 1730164591 is valid because the calculated check digit 1 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 |
|---|---|---|---|
| 1164407615 | DR. CHRISTOPHER M GODELL M.D. Individual | Internal Medicine (Gastroenterology) | 11111 RESEARCH BLVD SUITE 390 AUSTIN, TX 78759 (512) 244-2273 |
| 1114902228 | DR. KENNETH K ELLIS M.D. Individual | Internal Medicine (Gastroenterology) | 11111 RESEARCH BLVD SUITE 390 AUSTIN, TX 78759 (512) 244-2273 |
| 1205811296 | DR. JOHN J ZIEBERT M.D. Individual | Internal Medicine (Gastroenterology) | 11111 RESEARCH BLVD SUITE 390 AUSTIN, TX 78759 (512) 244-2273 |
| 1902849805 | DR. JASON MICHAEL MELEAR M.D. Individual | Internal Medicine (Medical Oncology) | 11111 RESEARCH BLVD SUITE 400 AUSTIN, TX 78759 (512) 419-9733 |
| 1215047402 | DR. PATRICIA JEANNE MORRISON MD Individual | Surgery | 11111 RESEARCH BLVD STE 380 AUSTIN, TX 78759 (512) 338-5201 |
| 1104907492 | DR. MARILYN MEADE MCCLUSKEY M.D. Individual | Specialist | 11111 RESEARCH BLVD STE 170 AUSTIN, TX 78759 (512) 338-5222 |
| 1760558555 | PREMIER EYE CARE, PA Organization | Specialist | 11111 RESEARCH BLVD SUITE 170 AUSTIN, TX 78759 (512) 338-5222 |
| 1174778625 | TEXAS CARDIOVASCULAR CONSULTANTS, PA Organization | Internal Medicine (Cardiovascular Disease) | 11111 RESEARCH BLVD SUITE 360 AUSTIN, TX 78759 (512) 617-6000 |
| 1790010585 | AUSTIN TEXAS RADIATION ONCOLOGY GROUP, PA Organization | Specialist | 11111 RESEARCH BLVD AUSTIN, TX 78759 (512) 531-5200 |
| 1104139575 | CARDIOVASCULAR ASSOCIATES NORTHWEST PLLC Organization | Internal Medicine (Cardiovascular Disease) | 11111 RESEARCH BLVD SUITE 360 AUSTIN, TX 78759 (512) 617-1916 |
| 1679851901 | DEIRDRE M RHOAD M D P A Organization | Specialist | 11111 RESEARCH BLVD SUITE 310 AUSTIN, TX 78759 (512) 476-9149 |
| 1376545186 | MARSHA HILLARY ONAN M.D. Individual | Ophthalmology | 11111 RESEARCH BLVD SUITE 220 AUSTIN, TX 78759 (512) 324-6755 |
| 1538326871 | INTERVENTIONAL PAIN ASSOCIATES Organization | Anesthesiology (Pain Medicine) | 11111 RESEARCH BLVD SUITE 370 AUSTIN, TX 78759 (512) 795-7575 |
| 1720223449 | LAN T HOANG M.D. Individual | Ophthalmology | 11111 RESEARCH BLVD SUITE 220 AUSTIN, TX 78759 (512) 324-6755 |
| 1679632905 | GREGORY J MCCLELLAND P.A. Individual | Physician Assistant | 11111 RESEARCH BLVD SUITE 300 AUSTIN, TX 78759 (512) 380-9200 |
| 1184796401 | DR. JASON FULLMER MD Individual | Pediatrics (Pediatric Pulmonology) | 11111 RESEARCH BLVD SUITE 300 AUSTIN, TX 78759 (512) 380-9200 |
| 1013089218 | DR. JORDAN SCALO MD Individual | Pediatrics (Pediatric Pulmonology) | 11111 RESEARCH BLVD SUITE 300 AUSTIN, TX 78759 (512) 380-9200 |
| 1144415936 | BAOPING QIAN M.D. Individual | Pediatrics | 11111 RESEARCH BLVD STE 295 AUSTIN, TX 78759 (877) 800-5722 |
| 1447215249 | LARRY BRIT LAWRENCE MD Individual | Obstetrics & Gynecology | 11111 RESEARCH BLVD SUITE 230 AUSTIN, TX 78759 (877) 800-5722 |
| 1740267525 | GREGORY KITTREDGE BELL MD Individual | Radiology (Diagnostic Radiology) | 11111 RESEARCH BLVD LL2 AUSTIN, TX 78759 (512) 334-5201 |
Frequently Asked Questions
What is Brian Shimkus MD NPI number?
The NPI number assigned to this healthcare provider is 1730164591, registered as an "individual" on December 14, 2005
Where is Brian Shimkus MD located?
The provider is located at 11111 Research Blvd Ste. 450 Austin, Tx 78759 and the phone number is (512) 334-2103
Which is Brian Shimkus MD specialty?
The provider's speciality is Internal Medicine with a focus in Hematology & Oncology
How many years of experience does Brian Shimkus MD have?
The provider has more than 25 years of experience. He graduated from Medical College Of Georgia School Of Medicine in 1998.
What insurance does Brian Shimkus MD accept?
The provider might be accepting Medicaid and Medicare. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Is Brian Shimkus MD registered in PECOS?
Yes, as of January 10, 2023 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a Medicare beneficiary 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 are Brian Shimkus MD Quality Ratings?
The provider obtained a high score in the following performance measures: Documentation of Current Medications in the Medical Record , Oncology: Medical and Radiation - Pain Intensity Quantified. The quality ratings are based on unbiased reviews and reported submissions to Medicare's Quality Payment Program.
How much is a visit to Brian Shimkus MD?
Medicare beneficiaries should expect a typical cost of $179.81 with an average copayment of $44.95 for new patient appointments. Established patients should expect a typical charge of $105.96 and an average copayment of 26.49. Please review your insurance plan or contact the provider directly to determine your specific costs.
What are some of the services provided by Brian Shimkus MD?
The most common procedures or services performed by this practitioner are: Injection, dexamethasone sodium phosphate, 1mg, Complete blood cell count (red cells, white blood cell, platelets), automated test, Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour, Injection beneath the skin or into muscle for therapy, diagnosis, or prevention, Infusion of chemotherapy into a vein up to 1 hour, Insertion of needle into vein for collection of blood sample, Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour, Urinalysis, manual test, Nuclear medicine study with CT imaging skull base to mid-thigh and Administration of influenza virus vaccine.
How do I update my NPI information?
The NPI record of Brian Shimkus MD was last updated on December 14, 2005. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected]
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us at: [email protected]