DR. UNKNOWN BILORI M.D.
NPI 1760762090
Internal Medicine in Ansonia, CT
Quality Rating: 84.91 out of 100 score
NPI Status: Active since August 17, 2011
Contact Information
111 WAKELEE AVE
ANSONIA, CT
ZIP 06401
Phone: (203) 308-2781
Fax: (203) 308-2726
- Individual
- Female
- Years of Experience 18
- Internal Medicine
- PECOS Enrolled
- Accepts Medicare Approved Payment
- Medicare Quality Reporting
About UNKNOWN BILORI
Unknown Bilori is an internist established in Ansonia, Connecticut and her medical specialization is Internal Medicine with more than 18 years of experience. The healthcare provider is registered in the NPI registry with number 1760762090 assigned on August 2011. The practitioner's primary taxonomy code is 207R00000X with license number 53166 (CT). The provider is registered as an individual and her NPI record was last updated 5 years ago. Unknown Bilori operates as a multi-specialty business group with one or more individual providers who practice different areas of specialization.
- NPI
- 1760762090
- Provider Name
- DR. UNKNOWN BILORI M.D.
- Other Name
- BILORI BILORI
- Other Name Type
- Professional Name (2)
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 111 WAKELEE AVE ANSONIA, CT 06401
- Location Phone
- (203) 308-2781
- Location Fax
- (203) 308-2726
- Mailing Address
- 67 MAPLE AVE DERBY, CT 06418
- Mailing Phone
- (203) 732-1330
- Medical School Name
- OTHER
- Graduation Year
- 2006
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 08-17-2011
- Last Update Date
- 02-27-2019
- Code Navigator
An internist like Unknown Bilori 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.
Unknown Bilori 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 84.91, 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 following quality measures were reported for this provider: breast cancer screening, chronic care and preventative care management for empaneled patients, colorectal cancer screening, diabetes: eye exam, diabetes: medical attention for nephropathy, documentation of current medications in the medical record, e-prescribing, health information exchange, implementation of medication management practice improvements, measurement and improvement at the practice and panel level, medication reconciliation, patient-specific education, preventive care and screening: body mass index (bmi) screening and follow-up plan, preventive care and screening: screening for depression and follow-up plan, preventive care and screening: tobacco use: screening and cessation intervention, provide patient access, secure messaging, security risk analysis, specialized registry reporting and use of decision support and standardized treatment protocols.
The typical physician office visit costs for Medicare beneficiaries in this area are: $36.17 for a new patient copayment and $28.02 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
Internal Medicine
- Taxonomy Code
- 207R00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 53166
- License State
- CT
- Taxonomy Description
- A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
- NPI Profile Information
- Primary Taxonomy
- Group Taxonomy
- PECOS Enrollment and Medicare Status
- Durable Medical Equipment
- Physician Visit Costs
- Overall MIPS Quality Performance
- Quality Reporting
- Clinician Services
- Hospital Affiliations
- NPI Validation
- Other Providers Same Location
- Frequently Asked Questions
Location Map
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
PECOS Enrollment and Medicare Participation Status
Unknown Bilori 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: 4284850421
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: I20140724002185
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
Provider Referred Orders for Durable Medical Equipment, Devices & Supplies
The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.
Durable Medical Equipment
Other DME (D1E)
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (HCPCS:A4253)
5 DME suppliers used 17 Medicare Claims 39 Services Paid
Drugs Administered through DME (D1G)
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg (HCPCS:J7613)
2 DME suppliers used 23 Medicare Claims 1409 Services Paid
Drugs and Nutritional Products
Other drugs (O1E)
Pharmacy dispensing fee for inhalation drug(s); per 30 days (HCPCS:Q0513)
3 DME suppliers used 16 Medicare Claims 16 Services Paid
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 06401 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $144.69
- Minimum New Patient Price $63.47
- Maximum New Patient Price $190.87
- Average New Patient Copayment $36.17
- Minimum New Patient Copayment $15.86
- Maximum New Patient Copayment $47.71
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $112.09
- Minimum Established Patient Price $20.08
- Maximum Established Patient Price $156.18
- Average Established Patient Copayment $28.02
- Minimum Established Patient Copayment $5.02
- Maximum Established Patient Copayment $39.04
* 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: 84.91 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.
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Quality Score: 80.16
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: 82.77
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.
Quality Reporting
The following quality measures meet Medicare's statistical reporting standards for the year 2018. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Breast Cancer Screening | 69% | 264 |
| Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer | ||
| Chronic Care and Preventative Care Management for Empaneled Patients | Yes | N/A |
| Proactively manage chronic and preventive care for empaneled patients that could include one or more of the following: • Provide patients annually with an opportunity for development and/or adjustment of an individualized plan of care as appropriate to age and health status, including health risk appraisal; gender, age and condition-specific preventive care services; and plan of care for chronic conditions; • Use condition-specific pathways for care of chronic conditions (e.g., hypertension, diabetes, depression, asthma and heart failure) with evidence-based protocols to guide treatment to target; such as a CDC-recognized diabetes prevention program; • Use pre-visit planning to optimize preventive care and team management of patients with chronic conditions; • Use panel support tools (registry functionality) to identify services due; • Use predictive analytical models to predict risk, onset and progression of chronic diseases; or • Use reminders and outreach (e.g., phone calls, emails, postcards, patient portals and community health workers where available) to alert and educate patients about services due; and/or routine medication reconciliation. | ||
| Colorectal Cancer Screening | 65% | 442 |
| Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer | ||
| Diabetes: Eye Exam | 44% | 141 |
| Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period | ||
| Diabetes: Medical Attention for Nephropathy | 86% | 141 |
| The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period | ||
| Documentation of Current Medications in the Medical Record | 99% | 2411 |
| Percentage of visits for patients aged 18 years and older for which the eligible professional or 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 | ||
| e-Prescribing | 98% | 8472 |
| At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology. | ||
| Health Information Exchange | 86% | 1070 |
| The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for at least one transition of care or referral. | ||
| Implementation of medication management practice improvements | Yes | N/A |
| Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/or Conduct periodic, structured medication reviews. | ||
| Measurement and Improvement at the Practice and Panel Level | Yes | N/A |
| Measure and improve quality at the practice and panel level, such as the American Board of Orthopaedic Surgery (ABOS) Physician Scorecards, that could include one or more of the following: • Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice level and at the level of the care team or MIPS eligible clinician or group (panel); and/or • Use relevant data sources to create benchmarks and goals for performance at the practice level and panel level. | ||
| Medication Reconciliation | 99% | 557 |
| The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician. | ||
| Patient-Specific Education | 63% | 1338 |
| The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician. | ||
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | 79% | 1295 |
| 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 Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2 | ||
| Preventive Care and Screening: Screening for Depression and Follow-Up Plan | 73% | 999 |
| Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen | ||
| Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | 85% | 742 |
| 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 | ||
| Provide Patient Access | 98% | 1338 |
| At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information. | ||
| Secure Messaging | 18% | 1338 |
| For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period. | ||
| Security Risk Analysis | Yes | N/A |
| Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process. | ||
| Specialized Registry Reporting | Yes | N/A |
| The MIPS eligible clinician is in active engagement to submit data to specialized registry. To earn a 5 % bonus in the promoting interoperability performance category score for submitting to one or more public health or clinical data registries also attest to PI_TRANS_PHCDRR_3_MULTI. | ||
| Use of decision support and standardized treatment protocols | Yes | N/A |
| Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs. | ||
Clinician Services
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 2020. The reported codes are based on the top 5 codes for each available specialty, excluding evaluation and management codes.
- 27
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit (HCPCS:G0439)
- 19
Administration of influenza virus vaccine (HCPCS:G0008)
Hospital Affiliations
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. Unknown Bilori is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| GRIFFIN HOSPITAL | 130 DIVISION ST DERBY, CT 6418 | (203) 732-7500 | Acute Care Hospitals |
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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. | |||||||||
| 1 | 7 | 6 | 0 | 7 | 6 | 2 | 0 | 9 | 0 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 7 | 12 | 0 | 14 | 6 | 4 | 0 | 18 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 7 + 1 + 2 + 0 + 1 + 4 + 6 + 4 + 0 + 1 + 8 + 24 = 60 | |||||||||
| Step 3: because the number obtained in step 2 ends in zero, the check digit is zero. | |||||||||
| 0 | |||||||||
The NPI number 1760762090 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 4 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1043599178 | SANGEETHA RAJAN M.D. Individual | Internal Medicine | 111 WAKELEE AVE ANSONIA, CT 06401 (203) 308-2781 |
| 1679035323 | DR. CHASE AUSTIN BOARD PHARMD Individual | Pharmacist (Ambulatory Care) | 111 WAKELEE AVE ANSONIA, CT 06401 (540) 797-7367 |
| 1841486149 | DR. DAVID R MARKS M.D. Individual | Internal Medicine | 111 WAKELEE AVE ANSONIA, CT 06401 (203) 308-2781 |
| 1265939540 | DR. AISHA KHAN MD Individual | Internal Medicine | 111 WAKELEE AVE ANSONIA, CT 06401 (203) 308-2781 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1760762090, enumerated in the NPI registry as an "individual" on August 17, 2011
The provider is located at 111 Wakelee Ave Ansonia, Ct 06401 and the phone number is (203) 308-2781
The provider's speciality is Internal Medicine with taxonomy code 207R00000X
The provider has more than 18 years of experience.
Yes, as of May 10, 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 $144.69 with an average copayment of $36.17 for new patient appointments. Established patients should expect a typical charge of $112.09 and an average copayment of 28.02. Please review your insurance plan or contact the provider directly to determine your specific costs.
The most common procedures or services performed by this practitioner are: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit and Administration of influenza virus vaccine.
The practitioner is affiliated to the following hospital(s): GRIFFIN HOSPITAL. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
This NPI record was last updated on August 17, 2011. 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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