JAMES S. CAIN M.D.
NPI 1770581761
Internal Medicine - Nephrology in Roanoke, VA

Quality Rating: 69.99 out of 100 score

NPI Status: Active since July 13, 2005

Contact Information

2602 FRANKLIN RD SW
ROANOKE, VA
ZIP 24014
Phone: (540) 344-1400
Fax: (540) 344-7133

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Table of Contents

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Medicare Participation & PECOS Status
Areas of Expertise
Durable Medical Equipment
Physician Visit Costs
Overall Quality Performance
Quality Reporting
Hospital Affiliations - Privileges
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Male
Years of Experience 41
Internal Medicine
Nephrology
Accepts Medicare Approved Payment
PECOS Enrolled
Medicare Quality Reporting

About JAMES CAIN

This page provides the complete NPI Profile along with additional information for James Cain, an internist established in Roanoke, Virginia with a medical specialization in Internal Medicine, focusing in nephrology and more than 41 years of experience. He graduated from Eastern Virginia Medical School in 1985. The healthcare provider is registered in the NPI registry with number 1770581761 assigned on July 2005. The practitioner's primary taxonomy code is 207RN0300X with license number 0101041253 (VA). The provider is registered as an individual and his NPI record was last updated 4 years ago.

NPI: 1770581761
Provider Name: JAMES S. CAIN M.D.
Gender: Male
Entity Type: Individual
Location Address: 2602 FRANKLIN RD SW ROANOKE, VA 24014
Location Phone: (540) 344-1400
Location Fax: (540) 344-7133
Mailing Address: 2602 FRANKLIN RD SW ROANOKE, VA 24014
Mailing Phone: (540) 344-1400
Mailing Fax: (540) 344-7133
Medical School Name: EASTERN VIRGINIA MEDICAL SCHOOL
Graduation Year: 1985
Is Sole Proprietor?: No
Enumeration Date: 07-13-2005
Last Update Date: 03-26-2021
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An internist like James Cain 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.

Location Map

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 Nephrology
Taxonomy Code: 207RN0300X
Type: Allopathic & Osteopathic Physicians
License No.: 0101041253
License State: VA
Taxonomy Description: An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.

Insurance Plans Accepted

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

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*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
6102301	MEDICAID (05)	VA

Medicare Participation & PECOS Enrollment Status

James Cain 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.

James Cain 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: 8224135462
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: I20100427000386
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.

Unknown

Treatment-Treatment - Miscellaneous (RX029N)
Prednisone, immediate release or delayed release, oral, 1 mg (HCPCS:J7512)
1 DME suppliers used 11 Medicare Claims 1650 Services Paid

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.

Blood count, hemoglobin
Blood test, comprehensive group of blood chemicals
Blood test, lipids (cholesterol and triglycerides)
Complete blood cell count (red cells, white blood cell, platelets), automated test
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count
Creatinine level to test for kidney function or muscle injury
Dialysis procedure including 1 evaluation
Dialysis services, 1 physician visit per month (20 years or older)
Dialysis services, 2-3 physician visits per month (20 years or older)
Dialysis services, 4 or more physician visits per month (20 years or older)
Established patient office or other outpatient visit, 20-29 minutes
Established patient office or other outpatient visit, 30-39 minutes
Established patient office or other outpatient visit, 40-54 minutes
Established patient office or other outpatient visit, 40-54 minutes
Ferritin (blood protein) level
Follow-up hospital inpatient care per day, typically 15 minutes
Follow-up hospital inpatient care per day, typically 25 minutes
Follow-up hospital inpatient care per day, typically 35 minutes
Hemodialysis procedure with physician evaluation
Initial hospital inpatient care per day, typically 50 minutes
Injection of drug or substance into vein
Injection, iron sucrose, 1 mg
Insertion of needle into vein for collection of blood sample
Iron binding capacity
Iron level
Kidney function blood test panel
Magnesium level
Manual urinalysis test with examination using microscope, non-automated
Parathormone (parathyroid hormone) level
Total protein level, urine
Vitamin d-3 level

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $32.26 for a new patient copayment and $24.78 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 24014 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99204

Average New Patient Price $129.04
Minimum New Patient Price $56.19
Maximum New Patient Price $170.3

Average New Patient Copayment $32.26
Minimum New Patient Copayment $14.04
Maximum New Patient Copayment $42.57

Established Patients Visit Costs *

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

Average Established Patient Price $99.13
Minimum Established Patient Price $18.07
Maximum Established Patient Price $138.91

Average Established Patient Copayment $24.78
Minimum Established Patient Copayment $4.51
Maximum Established Patient Copayment $34.72

* 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 69.99, 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: 69.99 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: 85.48

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: 0

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: 81.16

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: 81.16

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 provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. 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
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.
Diabetes: Medical Attention for Nephropathy	93%	138
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
e-Prescribing	98%	602
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Immunization Registry Reporting	Yes	N/A
The MIPS eligible clinician is in active engagement with a public health agency to submit immunization data.
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%	85
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	12%	253
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.
Pneumococcal Vaccination Status for Older Adults	22%	277
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
Population empanelment	Yes	N/A
Empanel (assign responsibility for) the total population, linking each patient to a MIPS eligible clinician or group or care team. Empanelment is a series of processes that assign each active patient to a MIPS eligible clinician or group and/or care team, confirm assignment with patients and clinicians, and use the resultant patient panels as a foundation for individual patient and population health management. Empanelment identifies the patients and population for whom the MIPS eligible clinician or group and/or care team is responsible and is the foundation for the relationship continuity between patient and MIPS eligible clinician or group /care team that is at the heart of comprehensive primary care. Effective empanelment requires identification of the “active population” of the practice: those patients who identify and use your practice as a source for primary care. There are many ways to define “active patients” operationally, but generally, the definition of “active patients” includes patients who have sought care within the last 24 to 36 months, allowing inclusion of younger patients who have minimal acute or preventive health care.
Provide Patient Access	18%	253
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.
Regular Review Practices in Place on Targeted Patient Population Needs	Yes	N/A
Implementation of regular reviews of targeted patient population needs, such as structured clinical case reviews, which includes access to reports that show unique characteristics of eligible clinician's patient population, identification of vulnerable patients, and how clinical treatment needs are being tailored, if necessary, to address unique needs and what resources in the community have been identified as additional resources.
Secure Messaging	5%	253
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.
Syndromic Surveillance Reporting	Yes	N/A
The MIPS eligible clinician is in active engagement with a public health agency to submit syndromic surveillance data. 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_2_MULTI.
Use of High-Risk Medications in the Elderly	2% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better.	277
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 medication

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. James Cain is affiliated with the following medical facilities:

Hospital Name	Address	Phone	Hospital Type
CARILION MEDICAL CENTER	1906 BELLEVIEW AVENUE, SE ROANOKE, VA 24014	(540) 981-7000	Acute Care Hospitals
LEWISGALE MEDICAL CENTER	1900 ELECTRIC ROAD SALEM, VA 24153	(540) 776-4000	Acute Care Hospitals
TWIN COUNTY REGIONAL HOSPITAL	200 HOSPITAL DRIVE GALAX, VA 24333	(276) 236-8181	Acute Care Hospitals

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	7	0	5	8	1	7	6	1
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	7	14	0	10	8	2	7	12
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 7 + 1 + 4 + 0 + 1 + 0 + 8 + 2 + 7 + 1 + 2 + 24 = 59
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 59 = 1									1

The NPI number 1770581761 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.

KATHY M CAVANAUGH N.P.

Internal Medicine

(Nephrology)

2602 FRANKLIN RD SW
ROANOKE, VA
ZIP 24014

About JAMES CAIN

Location Map

Specialty - Primary Taxonomy

Internal Medicine Nephrology

Insurance Plans Accepted

Medicare

Medicaid

Additional Identifiers

Medicare Participation & PECOS Enrollment Status

Is the provider registered in PECOS? Yes

PECOS PAC ID: 8224135462

PECOS Enrollment ID: I20100427000386

Accepts Medicare Assignment? Yes

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

Unknown

Areas of Expertise

Blood count, hemoglobin

Blood test, comprehensive group of blood chemicals

Blood test, lipids (cholesterol and triglycerides)

Complete blood cell count (red cells, white blood cell, platelets), automated test

Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count

Creatinine level to test for kidney function or muscle injury

Dialysis procedure including 1 evaluation

Dialysis services, 1 physician visit per month (20 years or older)

Dialysis services, 2-3 physician visits per month (20 years or older)

Dialysis services, 4 or more physician visits per month (20 years or older)

Established patient office or other outpatient visit, 20-29 minutes

Established patient office or other outpatient visit, 30-39 minutes

Established patient office or other outpatient visit, 40-54 minutes

Established patient office or other outpatient visit, 40-54 minutes

Ferritin (blood protein) level

Follow-up hospital inpatient care per day, typically 15 minutes

Follow-up hospital inpatient care per day, typically 25 minutes

Follow-up hospital inpatient care per day, typically 35 minutes

Hemodialysis procedure with physician evaluation

Initial hospital inpatient care per day, typically 50 minutes

Injection of drug or substance into vein

Injection, iron sucrose, 1 mg

Insertion of needle into vein for collection of blood sample

Iron binding capacity

Iron level

Kidney function blood test panel

Magnesium level

Manual urinalysis test with examination using microscope, non-automated

Parathormone (parathyroid hormone) level

Total protein level, urine

Vitamin d-3 level

Physician Visit Costs

New Patients Visit Costs *

Established Patients Visit Costs *

Overall MIPS Quality Performance

Final Score: 69.99 out of 100

Quality Score: 85.48

Promoting Interoperability Score: 0

Improvement Activities Score: 40

Cost Score: 81.16

Cost Score: 81.16

Quality Reporting

Find Provider Hospital Affiliations - Privileges

Reviews for JAMES S. CAIN M.D.

NPI Validation Check Digit Calculation

Other Providers at the Same Location

Frequently Asked Questions

What is James Cain's NPI number?

Where is the provider located?

What is the provider's specialty?

What insurance does James Cain accept?

Is James Cain affiliated with any hospitals?