JAMES PAUL GAY M.D.
NPI 1750338042
Family Medicine in Oak View, CA


Quality Rating: 95.72 out of 100 score

NPI Status: Active since May 30, 2006

Contact Information

655 VENTURA AVE
OAK VIEW, CA
ZIP 93022
Phone: (805) 649-3750
Fax: (805) 649-3780

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  • Individual
  • Male
  • Years of Experience 43
  • Family Medicine
  • PECOS Enrolled
  • Accepts Medicare Approved Payment

About JAMES GAY

James Gay is a primary care provider established in Oak View, California and his medical specialization is Family Medicine with more than 43 years of experience. He graduated from University Of Pittsburgh School Of Medicine in 1982. The healthcare provider is registered in the NPI registry with number 1750338042 assigned on May 2006. The practitioner's primary taxonomy code is 207Q00000X with license number G51718 (CA). The provider is registered as an individual and his NPI record was last updated 17 years ago.

NPI
1750338042
Provider Name
JAMES PAUL GAY M.D.
Gender
Male
Entity Type
Individual
Location Address
655 VENTURA AVE OAK VIEW, CA 93022
Location Phone
(805) 649-3750
Location Fax
(805) 649-3780
Mailing Address
2705 LOMA VISTA RD SUITE 205 VENTURA, CA 93003
Mailing Phone
(805) 667-2801
Mailing Fax
(805) 649-3780
Medical School Name
UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE
Graduation Year
1982
Is Sole Proprietor?
No
Enumeration Date
05-30-2006
Last Update Date
07-09-2007
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A primary care provider (PCP) like James Gay 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

James Gay 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.

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 95.72, 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: $24.65 for a new patient copayment and $28.45 for an established patient copayment.

Specialty - 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.

Classification

Family Medicine

Taxonomy Code
207Q00000X
Type
Allopathic & Osteopathic Physicians
License No.
G51718
License State
CA
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.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Medicare

  • Medicaid

  • Blue Cross Blue Shield


*Please verify directly with this provider to make sure your insurance plan is currently accepted.

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
058608MEDICARE ID-TYPE UNSPECIFIED (04)CARH MEDICARE
058553MEDICARE ID-TYPE UNSPECIFIED (04)CARH MEDICARE
050394MEDICARE ID-TYPE UNSPECIFIED (04)CAMEDICARE
WG51718JMEDICARE ID-TYPE UNSPECIFIED (04)CAPPIN
WG51718HMEDICARE ID-TYPE UNSPECIFIED (04)CAPPIN
WG51718IMEDICARE ID-TYPE UNSPECIFIED (04)CAPPIN
050394OTHER (01)CABLUE CROSS
WG51718LMEDICARE ID-TYPE UNSPECIFIED (04)CAPPIN
WG51718FMEDICARE ID-TYPE UNSPECIFIED (04)CAPPIN
RHM08609FMEDICAID (05)CA 
WG51718GMEDICARE ID-TYPE UNSPECIFIED (04)CAPPIN
RHM08608FMEDICAID (05)CA 
A52062MEDICARE UPIN (02) 
WG51718KMEDICARE ID-TYPE UNSPECIFIED (04)CAPPIN
058609MEDICARE ID-TYPE UNSPECIFIED (04)CARH MEDICARE
RHM18553HMEDICAID (05)CA 
ZZT40394FMEDICAID (05)CA 

PECOS Enrollment and Medicare Participation Status

James Gay 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: 3870533268

    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: I20050602000267

    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

Physician Visit Costs

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 93022 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

  • Average New Patient Price $98.6
  • Minimum New Patient Price $64.68
  • Maximum New Patient Price $192.84
  • Average New Patient Copayment $24.65
  • Minimum New Patient Copayment $16.17
  • Maximum New Patient Copayment $48.21

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

  • Average Established Patient Price $113.83
  • Minimum Established Patient Price $20.83
  • Maximum Established Patient Price $158.24
  • Average Established Patient Copayment $28.45
  • Minimum Established Patient Copayment $5.2
  • Maximum Established Patient Copayment $39.56

* 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 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: 95.72 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: 92.23

    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: 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.

  • Cost Score: 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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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.
1750338042
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
27100631608
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 7 + 1 + 0 + 0 + 6 + 3 + 1 + 6 + 0 + 8 + 24 = 58
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 58 = 22

The NPI number 1750338042 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 3 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1235435884 REBECCA STEPHENS MD
Individual
Family Medicine655 VENTURA AVE
OAK VIEW, CA 93022
(805) 649-3750
1750329967COMMUNITY MEMORIAL HEALTH SYSTEM
Organization
Clinic/Center (Rural Health)655 VENTURA AVE
OAK VIEW, CA 93022
(805) 649-3750
1871374264 RETA BIDI PA-C
Individual
Physician Assistant (Medical)655 VENTURA AVE
OAK VIEW, CA 93022
(805) 649-3750

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1750338042, enumerated in the NPI registry as an "individual" on May 30, 2006

The provider is located at 655 Ventura Ave Oak View, Ca 93022 and the phone number is (805) 649-3750

The provider's speciality is Family Medicine with taxonomy code 207Q00000X

The provider has more than 43 years of experience. He graduated from University Of Pittsburgh School Of Medicine in 1982.

The provider might be accepting Accepts: Medicare, Medicaid and Blue Cross Blue Shield. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Yes, as of July 16, 2024 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a 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.

The provider has an overall high rating in the following quality measures: quality clinical practices and patient outcomes and experiences , uses technology to exchange and make use of healthcare information.

Medicare beneficiaries should expect a typical cost of $98.6 with an average copayment of $24.65 for new patient appointments. Established patients should expect a typical charge of $113.83 and an average copayment of 28.45. Please review your insurance plan or contact the provider directly to determine your specific costs.

This NPI record was last updated on May 30, 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].
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.