KEVIN DON GAINES MD NPI 1740217793
Family Medicine in Gallup, NM
About KEVIN DON GAINES MD
Kevin Gaines is a primary care provider established in Gallup, New Mexico and his medical specialization is Family Medicine with more than 25 years of experience. He graduated from University Of Arkansas College Of Medicine in 1999. The healthcare provider is registered in the NPI registry with number 1740217793 assigned on June 2006. The practitioner's primary taxonomy code is 207Q00000X with license number 21745 (OK). The provider is registered as an individual and his NPI record was last updated 15 years ago.
| NPI | 1740217793 |
| Provider Name | KEVIN DON GAINES MD |
| Location Address | 516 E. NIZHONI BLVD GALLUP, NM 87301 |
| Location Phone | (505) 722-1000 |
| Mailing Address | PO BOX 1337 GALLUP, NM 87305 |
| Gender | Male |
| NPI Entity Type | Individual |
| Medical School Name | UNIVERSITY OF ARKANSAS COLLEGE OF MEDICINE |
| Graduation Year | 1999 |
| Is Sole Proprietor? | No |
| Enumeration Date | 06-26-2006 |
| Last Update Date | 04-11-2008 |
A primary care provider (PCP) like Kevin Gaines 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 Kevin Gaines 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.
Kevin Gaines 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 Gallup Indian 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 77.76, 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: $21.82 for a new patient copayment and $25.16 for an established patient copayment.
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.
| Taxonomy Code | 207Q00000X |
| Classification | Family Medicine |
| Type | Allopathic & Osteopathic Physicians |
| License No. | 21745 |
| License State | OK |
| 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. |
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
516 E. NIZHONI BLVD
GALLUP, NM
ZIP 87301
Phone: (505) 722-1000
Fax: (505) 726-8740
Mailing Address
PO BOX 1337
GALLUP, NM
ZIP 87305
Phone: (505) 722-1000
Fax: (505) 726-8740
Location Map
PECOS Enrollment and Medicare Participation Status
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 Medicare providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in the Medicare program need to enroll in PECOS with their NPI number to avoid denied claims.
| Registered in PECOS? | Yes |
| PECOS PAC ID | 9234039173 |
| PECOS Enrollment ID | I20040108001187 |
| 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 or refer Durable Medical Equipment (DMEPOS) | Yes |
| Eligible order r refer Home Health Agency (HHA) | Yes |
| Eligible order r 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 87301 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 |
| $56.4 | $173.32 | $87.31 |
| Minimum New Patient Copayment | Maximum New Patient Copayment | Typical New Patient Copayment |
| $14.1 | $43.33 | $21.82 |
| 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 |
| $17.1 | $141.02 | $100.67 |
| Minimum Established Patient Copayment | Maximum Established Patient Copayment | Typical Established Patient Copayment |
| $4.27 | $35.25 | $25.16 |
* 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% | 73.83 | |
|
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% | 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. |
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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 | - | 77.76 | |
| 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. Kevin Gaines is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | CMS Certification Number (CCN) | Overall Rating |
|---|---|---|---|---|---|
| GALLUP INDIAN MEDICAL CENTER | 516 E NIZHONI BLVD GALLUP, NM 87301 | (505) 722-1000 | Acute Care Hospitals | 320061 |
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 8HBT73 | MEDICARE ID-TYPE UNSPECIFIED (04) | TX | HSZ197 |
| 8HBG15 | MEDICARE ID-TYPE UNSPECIFIED (04) | TX | HSZ005 |
| H24200 | MEDICARE UPIN (02) | ||
| 8HBG13 | MEDICARE ID-TYPE UNSPECIFIED (04) | TX | HSZ003 |
| 758196 | MEDICAID (05) | AZ | |
| 8HBG12 | MEDICARE ID-TYPE UNSPECIFIED (04) | TX | HSZ002 |
| 8HBG11 | MEDICARE ID-TYPE UNSPECIFIED (04) | TX | HSZ001 |
| 8HBG16 | MEDICARE ID-TYPE UNSPECIFIED (04) | TX | HSZ006 |
| 09101071 | MEDICAID (05) | NM |
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 | 4 | 0 | 2 | 1 | 7 | 7 | 9 | 3 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 7 | 8 | 0 | 4 | 1 | 14 | 7 | 18 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 7 + 8 + 0 + 4 + 1 + 1 + 4 + 7 + 1 + 8 + 24 = 67 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 67 = 3 | 3 | ||||||||
The NPI number 1740217793 is valid because the calculated check digit 3 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 |
|---|---|---|---|
| 1366427650 | DR. GIENIA LYNCH MD Individual | Obstetrics & Gynecology | 516 E. NIZHONI BLVD GALLUP INDIAN MEDICAL CENTER GALLUP, NM 87301 (505) 722-1000 |
| 1366420747 | EILEEN BIUNNO MD Individual | Radiology (Diagnostic Radiology) | 516 E. NIZHONI BLVD GALLUP, NM 87301 (505) 722-1000 |
| 1376511485 | UMA D DUGGIRALA MD Individual | Family Medicine | 516 E. NIZHONI BLVD GALLUP INDIAN MEDICAL CENTER GALLUP, NM 87301 (505) 722-1000 |
| 1619910080 | EDWARD ROBLES MEDINA MD Individual | Anesthesiology | 516 E. NIZHONI BLVD GALLUP, NM 87301 (505) 722-1000 |
| 1902833973 | SEYED HESHMAT MORTAZAVI DMD Individual | Dentist | 516 E. NIZHONI BLVD GALLUP, NM 87301 (505) 722-1000 |
| 1063449577 | JOVITO G SABAL D.D.S Individual | Dentist | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 (505) 722-1000 |
| 1740218874 | ANTHONY VITALI DMD Individual | Dentist | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 (505) 722-1000 |
| 1891723748 | STEVEN DEWAYNE FLORER DDS Individual | Dentist | 516 E. NIZHONI BLVD GALLUP, NM 87301 (505) 722-1000 |
| 1184653941 | JEANMAIRE RENE OFFNER M.D. Individual | Internal Medicine | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 (505) 722-1262 |
| 1023048840 | GERI A GOFFE CNM Individual | Registered Nurse | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 (505) 722-1000 |
| 1497785224 | BARBARA A SHEBALA CNP Individual | Nurse Practitioner | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 (505) 722-1000 |
| 1205867603 | GARY A ESCUDERO M.D. Individual | Pediatrics | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 (505) 722-1000 |
| 1629009998 | TERRANCE W SLOAN M.D. Individual | Internal Medicine | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 (505) 722-1000 |
| 1942230610 | BRIAN CULLIGAN O.D. Individual | Optometrist | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 (505) 722-1000 |
| 1902830037 | DEBORA J RUSSELL M.D. Individual | Obstetrics & Gynecology | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 (505) 722-1000 |
| 1528169950 | CHRISTINE CASTILLO RPH Individual | Pharmacist | 516 E. NIZHONI BLVD GALLUP, NM 87301 (505) 722-1185 |
| 1821136573 | DENISE A. NORMAN RPH Individual | Pharmacist | 516 E. NIZHONI BLVD GALLUP INDIAN MEDICAL CENTER (GIMC) GALLUP, NM 87301 (505) 722-1185 |
| 1205960044 | EDWARD T HUI MD Individual | Neurological Surgery | 516 E. NIZHONI BLVD GALLUP, NM 87301 (505) 722-1000 |
| 1003009945 | MRS. SANDRA L SKEETS RN Individual | Registered Nurse (Ambulatory Care) | 516 E. NIZHONI BLVD GALLUP, NM 87301 (505) 722-1000 |
| 1285803577 | MS. DEVON AURORA MCCABE RN Individual | Registered Nurse | 516 E. NIZHONI BLVD GALLUP, NM 87301 (505) 722-1000 |
Frequently Asked Questions
What is Kevin Gaines MD NPI number?
The NPI number assigned to this healthcare provider is 1740217793, enumerated in the NPI registry as an "individual" on June 26, 2006
Where is the provider located?
The provider is located at 516 E. Nizhoni Blvd Gallup, Nm 87301 and the phone number is (505) 722-1000
What is the provider specialty code?
The provider's speciality is Family Medicine with taxonomy code 207Q00000X
How many years of experience does Kevin Gaines MD have?
The provider has more than 25 years of experience. He graduated from University Of Arkansas College Of Medicine in 1999.
What insurance does Kevin Gaines 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 Kevin Gaines MD registered in PECOS?
Yes, as of September 14, 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.
How much is a visit to Kevin Gaines MD?
Medicare beneficiaries should expect a typical cost of $87.31 with an average copayment of $21.82 for new patient appointments. Established patients should expect a typical charge of $100.67 and an average copayment of 25.16. Please review your insurance plan or contact the provider directly to determine your specific costs.
Is Kevin Gaines MD affiliated to any hospitals?
The practitioner is affiliated to the following hospitals: GALLUP INDIAN MEDICAL CENTER. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
How do I update my NPI information?
This NPI record was last updated on June 26, 2006. 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].
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