MRS. COLLEEN MARIE DURHAM RPT
NPI 1780987586
Physical Therapist in Hazel Green, AL

NPI Status: Active since December 16, 2010

Contact Information

12819 HWY 231 431 N
HAZEL GREEN, AL
ZIP 35750
Phone: (256) 829-9544
Fax: (256) 829-9522

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  • Individual
  • Female
  • Years of Experience 19
  • Physical Therapist
  • Accepts Medicare Approved Payment

About COLLEEN DURHAM

Colleen Durham is a provider established in Hazel Green, Alabama and her medical specialization is Physical Therapist with more than 19 years of experience. The healthcare provider is registered in the NPI registry with number 1780987586 assigned on December 2010. The practitioner's primary taxonomy code is 225100000X with license number 35201 (AL). The provider is registered as an individual and her NPI record was last updated 13 years ago.

NPI
1780987586
Provider Name
MRS. COLLEEN MARIE DURHAM RPT
Gender
Female
Entity Type
Individual
Location Address
12819 HWY 231 431 N HAZEL GREEN, AL 35750
Location Phone
(256) 829-9544
Location Fax
(256) 829-9522
Mailing Address
12819 HWY 231 431 N HAZEL GREEN, AL 35750
Mailing Phone
(256) 829-9544
Mailing Fax
(256) 829-9522
Medical School Name
OTHER
Graduation Year
2005
Is Sole Proprietor?
Yes
Enumeration Date
12-16-2010
Last Update Date
12-16-2010
Code Navigator

Colleen Durham 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 typical physician office visit costs for Medicare beneficiaries in this area are: $21.48 for a new patient copayment and $17.46 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

Physical Therapist

Taxonomy Code
225100000X
Type
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
License No.
35201
License State
AL
Taxonomy Description
Physical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles. PTs:
  • Diagnose and manage movement dysfunction and enhance physical and functional abilities.
  • Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.
  • Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.
  • Treat conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems.
  • Address the negative effects attributable to unique personal and environmental factors as they relate to human performance.
PTs provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a PT practices.

Insurance Plans Accepted

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

  • Ambetter from Magnolia Health

    • Ambetter Virtual Access Bronze (Virtual PCP selection required) - HMO
    • Ambetter Virtual Access Gold (Virtual PCP selection required) - HMO
    • Ambetter Virtual Access Silver (Virtual PCP selection required) - HMO
    • Choice Bronze HSA with Walgreens - HMO
    • Choice Bronze HSA with Walgreens + Vision + Adult Dental - HMO
    • Clear Silver with Walgreens - HMO
    • Clear Silver with Walgreens + Vision + Adult Dental - HMO
    • Complete Gold with Walgreens - HMO
    • Complete Gold with Walgreens + Vision + Adult Dental - HMO
    • Complete Silver with Walgreens - HMO
  • Ambetter from Peach State Health Plan

    • Choice Bronze HSA - HMO
    • Choice Bronze HSA + Vision + Adult Dental - HMO
    • Clear Bronze - HMO
    • Clear Bronze + Vision + Adult Dental - HMO
    • Clear Gold - HMO
    • Clear Gold + Vision + Adult Dental - HMO
    • Clear Silver - HMO
    • Clear Silver + Vision + Adult Dental - HMO
    • Complete Gold - HMO
    • Complete Gold + Vision + Adult Dental - HMO
  • Ambetter from Sunshine Health

    • Ambetter Virtual Access Bronze (Virtual PCP selection required) - HMO
    • Ambetter Virtual Access Gold (Virtual PCP selection required) - HMO
    • Ambetter Virtual Access Silver (Virtual PCP selection required) - HMO
    • Choice Bronze HSA - EPO
    • Choice Bronze HSA + Vision + Adult Dental - EPO
    • Clear Silver - EPO
    • Clear Silver + Vision + Adult Dental - EPO
    • Complete Gold - EPO
    • Complete Gold + Vision + Adult Dental - EPO
    • Elite Bronze - EPO
  • Ambetter of Alabama

    • Choice Bronze HSA - EPO
    • Choice Bronze HSA + Vision + Adult Dental - EPO
    • Clear Silver - EPO
    • Clear Silver + Vision + Adult Dental - EPO
    • Elite Bronze - EPO
    • Elite Bronze + Vision + Adult Dental - EPO
    • Everyday Bronze - EPO
    • Everyday Bronze + Vision + Adult Dental - EPO
    • Everyday Silver - EPO
    • Everyday Silver + Vision + Adult Dental - EPO
  • Ambetter of Tennessee

    • Choice Bronze HSA - EPO
    • Choice Bronze HSA + Vision + Adult Dental - EPO
    • Clear Silver - EPO
    • Clear Silver + Vision + Adult Dental - EPO
    • Complete Gold - EPO
    • Complete Gold + Vision + Adult Dental - EPO
    • Complete Silver - EPO
    • Complete Silver + Vision + Adult Dental - EPO
    • Elite Bronze - EPO
    • Elite Bronze + Vision + Adult Dental - EPO
  • Blue Cross and Blue Shield of Alabama

    • Blue HSA Bronze - PPO
    • Blue Protect - PPO
    • Blue Saver Bronze - PPO
    • Blue Value Gold - PPO
    • Blue Value Silver - PPO
    • Blue Access Gold for Business - PPO
    • Blue Choice Platinum for Business - PPO
    • Blue HSA Silver for Business - PPO
    • Blue Saver Bronze for Business - PPO
    • Blue Saver Gold for Business - PPO

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

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 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.

  • PECOS PAC ID: 2062692460

    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: I20110201000920

    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.

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 35750 ZIP code area.

New Patients Visit Costs *

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

  • Average New Patient Price $85.95
  • Minimum New Patient Price $55.54
  • Maximum New Patient Price $170.61
  • Average New Patient Copayment $21.48
  • Minimum New Patient Copayment $13.88
  • Maximum New Patient Copayment $42.65

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

  • Average Established Patient Price $69.84
  • Minimum Established Patient Price $16.93
  • Maximum Established Patient Price $139.08
  • Average Established Patient Copayment $17.46
  • Minimum Established Patient Copayment $4.23
  • Maximum Established Patient Copayment $34.77

* 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.

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.

  • 1906

    Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes (HCPCS:97110)

  • 1188

    Manual (physical) therapy techniques to 1 or more regions, each 15 minutes (HCPCS:97140)

  • 706

    Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes (HCPCS:97112)

  • 63

    Evaluation of physical therapy, typically 30 minutes (HCPCS:97162)

  • 41

    Evaluation of physical therapy, typically 20 minutes (HCPCS:97161)

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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.
1780987586
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2716018814516
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 7 + 1 + 6 + 0 + 1 + 8 + 8 + 1 + 4 + 5 + 1 + 6 + 24 = 74
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
80 - 74 = 66

The NPI number 1780987586 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1063421857THERAFIT, LLC
Organization
Physical Therapist12819 HWY 231 431 N SUITE G
HAZEL GREEN, AL 35750
(256) 829-9544
1952310708MRS. MELINDA KAY BLACK PT,DPT
Individual
Physical Therapist12819 HWY 231 431 N SUITE G
HAZEL GREEN, AL 35750
(256) 829-9544

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1780987586, enumerated in the NPI registry as an "individual" on December 16, 2010

The provider is located at 12819 Hwy 231 431 N Hazel Green, Al 35750 and the phone number is (256) 829-9544

The provider's speciality is Physical Therapist with taxonomy code 225100000X

The provider has more than 19 years of experience.

The provider might be accepting Accepts: Ambetter from Magnolia Health, Ambetter from Peach. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Medicare beneficiaries should expect a typical cost of $85.95 with an average copayment of $21.48 for new patient appointments. Established patients should expect a typical charge of $69.84 and an average copayment of 17.46. 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: Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes, Manual (physical) therapy techniques to 1 or more regions, each 15 minutes, Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes, Evaluation of physical therapy, typically 30 minutes and Evaluation of physical therapy, typically 20 minutes.

This NPI record was last updated on December 16, 2010. 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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