GRETCHEN JOHNS MD
NPI 1750301172
Pathology - Clinical Pathology/Laboratory Medicine in Jacksonville, FL

Medicare Participation & PECOS Enrollment Status

Gretchen Johns 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.

Gretchen Johns 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: 9032278353

  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: I20090124000073

  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.

Antithrombin iii antigen (clotting inhibitor) activity

Antithrombin III antigen activity is a test that measures the level of Antithrombin, a protein in your blood that helps prevent clots from forming excessively. It's crucial for maintaining healthy blood flow. If levels are abnormal, it might indicate a clotting disorder.

This service was performed 15 times for 14 patients

Automated urinalysis test

An automated urinalysis test is a routine examination that checks your urine for various substances. It can help identify potential health issues such as kidney problems or diabetes. The test uses a machine to analyze a small urine sample, providing quick and accurate results.

This service was performed 202 times for 168 patients

Blood creatinine level

A blood creatinine level test measures the amount of creatinine in your blood. Creatinine is a waste product that your body produces when it uses energy. High levels may indicate that your kidneys aren't working properly. This test is often used to monitor kidney health.

This service was performed 3,734 times for 2,939 patients

Blood glucose (sugar) level

A blood glucose level test measures the amount of sugar in your blood. It's often used to monitor and manage conditions like diabetes. High or low levels can indicate a health issue. The test is usually done by pricking your finger for a small blood sample.

This service was performed 183 times for 123 patients

Blood test, clotting time

A clotting time blood test helps determine how quickly your blood forms clots, a process crucial to stop bleeding. During the test, a small blood sample is taken from your arm. The sample is then analyzed in a lab to see how long it takes for a clot to form.

This service was performed 10,672 times for 4,630 patients

Blood test, clotting time, substitution

A blood test for clotting time checks how long it takes for your blood to form a clot. This helps identify any bleeding or clotting disorders. Substitution refers to replacing missing or low clotting factors with donated blood products to help your blood clot properly.

This service was performed 11 times for 11 patients

Blood test, comprehensive group of blood chemicals

A comprehensive group of blood chemicals test, also known as a comprehensive metabolic panel, is a blood test that measures your sugar level, electrolyte and fluid balance, kidney function, and liver function. This helps to check your body's overall health.

This service was performed 112 times for 108 patients

Clotting factor ii prothrombin, measurement

The Clotting Factor II Prothrombin measurement is a blood test that helps determine how well your blood clots. It assesses the presence and activity of Factor II, a protein vital for blood clotting. This test is crucial in diagnosing bleeding disorders or monitoring treatment efficacy.

This service was performed 13 times for 13 patients

Clotting factor ix (ptc or christmas) measurement

Clotting Factor IX (PTC or Christmas) measurement is a blood test that determines the level of Factor IX, a protein involved in blood clotting. It's used to diagnose and monitor conditions like Hemophilia B, where Factor IX is deficient or absent, affecting blood's ability to clot.

This service was performed 13 times for 13 patients

Clotting factor v (acg or proaccelerin) measurement

Clotting Factor V measurement is a blood test that helps determine how well your body's clotting process is working. It's crucial for preventing excessive bleeding. If levels are abnormal, it could indicate a bleeding disorder or thrombosis risk.

This service was performed 11 times for 11 patients

Clotting factor vii (proconvertin, stable factor)

Clotting Factor VII, also known as Proconvertin or Stable Factor, is a protein in the blood that helps with clotting. It's essential for preventing excessive bleeding. If you lack Factor VII, you may need treatment to replace it, ensuring your blood can clot properly.

This service was performed 17 times for 17 patients

Clotting factor viii (ahg) measurement

Clotting Factor VIII (AHG) measurement is a blood test to check the levels of Factor VIII, a protein that helps blood to clot. This test is often used to diagnose and manage bleeding disorders, such as hemophilia A. Low levels may indicate a risk of excessive bleeding.

This service was performed 22 times for 22 patients

Clotting factor viii (vw factor) antigen

Clotting Factor VIII (VW Factor) Antigen is a blood test conducted to measure the levels of Factor VIII, a protein that aids in blood clotting. This test is crucial in diagnosing conditions related to abnormal bleeding or clotting.

This service was performed 13 times for 13 patients

Clotting factor x (stuart-prower) measurement

Clotting Factor X measurement is a blood test that assesses the functioning of Factor X, a protein essential for blood clotting. This test helps diagnose conditions like Factor X deficiency, which can cause excessive bleeding. It's important for understanding your overall blood health.

This service was performed 15 times for 15 patients

Clotting factor xi (pta) measurement

Clotting Factor XI (PTA) measurement is a blood test that helps in assessing your body's ability to form a blood clot. It's crucial in diagnosing bleeding disorders and monitoring treatment effectiveness. The process involves a simple blood draw.

This service was performed 17 times for 15 patients

Coagulation assessment blood test, plasma or whole blood

A coagulation assessment blood test evaluates how well your blood clots, helping identify potential bleeding or clotting disorders. This test uses a sample of your plasma or whole blood. It's a standard procedure to ensure your body's clotting process is functioning properly.

This service was performed 907 times for 827 patients

Coagulation function measurement, d-dimer; quantitative

A quantitative D-dimer test measures the amount of D-dimer, a protein fragment, in your blood. This test helps detect abnormal blood clotting. D-dimer levels can rise in conditions where clots are forming and breaking down, such as deep vein thrombosis or pulmonary embolism.

This service was performed 233 times for 190 patients

Coagulation function screening test with interpretation and report

A coagulation function screening test is a type of blood test that checks how well your blood clots. It's important because clotting helps prevent excessive bleeding. The test results are interpreted and a report is provided to help guide your doctor's treatment plan.

This service was performed 35 times for 34 patients

Coagulation function screening test with interpretation and report

A coagulation function screening test is a type of blood test that checks how well your blood clots. It's important because clotting helps prevent excessive bleeding. The test results are interpreted and a report is provided to help guide your doctor's treatment plan.

This service was performed 43 times for 42 patients

Fibrinogen (factor 1) activity measurement

Fibrinogen activity measurement is a blood test that helps understand your body's clotting ability. Fibrinogen, a protein, is essential for blood clot formation. If levels are abnormal, it might indicate a bleeding disorder or thrombotic condition. The test aids in diagnosing and managing these conditions.

This service was performed 94 times for 56 patients

Gene analysis (coagulation factor v) leiden variant

Gene analysis for the coagulation factor V Leiden variant is a test to identify a specific genetic mutation. This mutation can increase the risk of developing abnormal blood clots in veins. The test involves analyzing a sample of your DNA, usually taken from a blood sample.

This service was performed 13 times for 13 patients

Gene analysis (prothrombin, coagulation factor ii) a variant

Gene analysis for prothrombin (also known as coagulation factor II) is a test that examines your DNA to identify any variations in the prothrombin gene. These variations could potentially affect blood clotting, leading to an increased risk of certain health conditions.

This service was performed 15 times for 15 patients

Insertion of needle into vein for collection of blood sample

This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.

This service was performed 73,829 times for 25,834 patients

Measurement of blood coagulation and fibrinolysis (clot dissolving) function

This procedure tests how fast your blood clots and how well your body dissolves clots. It helps detect conditions that affect blood clotting and can guide treatment. It involves drawing a small amount of blood, which is then analyzed in a lab.

This service was performed 15 times for 15 patients

Phospholipid test

A phospholipid test is a blood test that helps detect abnormal antibodies related to your immune system. These antibodies may increase the risk of blood clots. The test aids in diagnosing conditions like lupus and other autoimmune disorders.

This service was performed 40 times for 39 patients

Protein c antigen (clotting inhibitor) measurement

The Protein C Antigen measurement is a blood test that assesses the level of Protein C, a natural substance that prevents clot formation. This test helps diagnose conditions related to abnormal clotting and can guide treatment plans.

This service was performed 15 times for 15 patients

Thrombin time, fibrinogen screening test, plasma

Thrombin time is a blood test that measures how long it takes for a clot to form in your blood. The fibrinogen screening test checks the level of fibrinogen, a protein that helps in clot formation. Plasma is the liquid part of your blood that carries cells and proteins.

This service was performed 25 times for 24 patients

Urine volume measurement

Urine volume measurement is a simple procedure to assess the amount of urine your body produces in a given time period. This helps to monitor your body's water balance and kidney function. You'll collect all urine in a special container for a set time, typically 24 hours.

This service was performed 1,900 times for 1,422 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $32.51 for a new patient copayment and $24.79 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 32224 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.

Overall MIPS Quality Performance

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 76.2, 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 Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS 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.

• Final Score: 76.2 out of 100

  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 Score: 69.33

  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 Score: 100

  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 Score: 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 activities measure category compromises 15% providers final MPIS scores.
  
  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 Score: 51.32

  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.

• Cost Score: 51.32

  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.

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical 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. Gretchen Johns is affiliated with the following medical facilities:

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