MR. PATRICK WILLIAM RILEY PA-C, ATC
NPI 1790765253
Physician Assistant in Duluth, MN
NPI Status: Active since January 20, 2006
Contact Information
407 E 3RD ST
EH ST MARY'S MEDICAL CENTER
DULUTH, MN
ZIP 55805
Phone: (218) 786-4626
- Individual
- Male
- Years of Experience 10
- Physician Assistant
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
About PATRICK RILEY
This page provides the complete NPI Profile along with additional information for Patrick Riley, a primary care provider established in Duluth, Minnesota with a medical specialization in Physician Assistant and more than 10 years of experience. The healthcare provider is registered in the NPI registry with number 1790765253 assigned on January 2006. The practitioner's primary taxonomy code is 363A00000X. The provider is registered as an individual and his NPI record was last updated 10 years ago.
- NPI
- 1790765253
- Provider Name
- MR. PATRICK WILLIAM RILEY PA-C, ATC
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 407 E 3RD ST EH ST MARY'S MEDICAL CENTER DULUTH, MN 55805
- Location Phone
- (218) 786-4626
- Mailing Address
- 400 E 3RD ST ESSENTIA HEALTH DULUTH CLINIC MCL2CRED DULUTH, MN 55805
- Mailing Phone
- (218) 786-1183
- Medical School Name
- OTHER
- Graduation Year
- 2016
- Is Sole Proprietor?
- No
- Enumeration Date
- 01-20-2006
- Last Update Date
- 08-09-2016
- Code Navigator
A primary care provider (PCP) like Patrick Riley 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
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
Physician Assistant
- Taxonomy Code
- 363A00000X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- License State
- MN
- Taxonomy Description
- A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 2255A2300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | 1525 (MN) |
| 2 | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 3855-23 (WI) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Anthem Bronze Preferred/Broad 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - POS
- Anthem Bronze Preferred/Broad HSA (+ Incentives) - POS
- Anthem Bronze Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Gold Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Gold Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Heart Healthy Bronze Preferred/Broad 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives) - POS
- Anthem Silver Preferred/Broad 4000 ($0 PCP Visits + $0 Select Drugs + Incentives) - POS
- Anthem Silver Preferred/Broad 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Silver Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Essentia Choice Care with Medica Bronze $0 Copay PCP Visits - HMO
- Essentia Choice Care with Medica Bronze HSA - EPO
- Essentia Choice Care with Medica Bronze Share - EPO
- Essentia Choice Care with Medica Bronze Share - HMO
- Essentia Choice Care with Medica Expanded Bronze Standard - EPO
- Essentia Choice Care with Medica Expanded Bronze Standard - HMO
- Essentia Choice Care with Medica Gold $0 Copay PCP Visits - EPO
- Essentia Choice Care with Medica Gold $0 Copay PCP Visits - HMO
- Essentia Choice Care with Medica Gold Share - EPO
- Essentia Choice Care with Medica Gold Share - HMO
- Essentia Choice Care with Medica Gold Standard - EPO
- Essentia Choice Care with Medica Gold Standard - HMO
- Essentia Choice Care with Medica Silver $0 Copay PCP Visits - EPO
- Essentia Choice Care with Medica Silver $0 Copay PCP Visits - HMO
- Essentia Choice Care with Medica Silver Share - EPO
- Essentia Choice Care with Medica Silver Share - HMO
- Essentia Choice Care with Medica Silver Standard - EPO
- Essentia Choice Care with Medica Silver Standard - HMO
- Medica Individual Choice Bronze $0 Copay PCP Visits - HMO
- Medica Individual Choice Bronze HSA - EPO
- Sanford Individual Simplicity $1,750 - PPO
- Sanford Individual Simplicity $10,600 - PPO
- Sanford Individual Simplicity $3,500 - PPO
- Sanford Individual Simplicity $4,750 - PPO
- Sanford Individual Simplicity $6,500 - PPO
- Sanford Individual Simplicity $7,200 HSA Qualified - PPO
- Sanford Individual Simplicity Standardized $2,000 - PPO
- Sanford Individual Simplicity Standardized $6,000 - PPO
- Sanford Individual Simplicity Standardized $7,500 - PPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medicare Participation & PECOS Enrollment Status
Patrick Riley 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.
Patrick Riley 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: 1557656444
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: I20160817001052
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.
Emergency department visit for life threatening or functioning severity
Emergency department visit for problem of high severity
Established patient office or other outpatient visit, 30-39 minutes
An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.
This service was performed 12 times for 12 patientsAn emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.
This service was performed 23 times for 23 patientsThis is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
This service was performed 11 times for 11 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $21.45 for a new patient copayment and $17.43 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 55805 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $85.82
- Minimum New Patient Price $56
- Maximum New Patient Price $168.28
- Average New Patient Copayment $21.45
- Minimum New Patient Copayment $14
- Maximum New Patient Copayment $42.07
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $69.74
- Minimum Established Patient Price $18.32
- Maximum Established Patient Price $138.04
- Average Established Patient Copayment $17.43
- Minimum Established Patient Copayment $4.58
- Maximum Established Patient Copayment $34.51
* 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.
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. Patrick Riley is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| ESSENTIA HEALTH ST MARY'S MEDICAL CENTER | 402 EAST SECOND STREET DULUTH, MN 55805 | (218) 786-3574 | Acute Care Hospitals | |
| ST CLAIR HOSPITAL | 1000 BOWER HILL ROAD PITTSBURGH, PA 15243 | (412) 942-4000 | Acute Care Hospitals | |
| ST MARYS HOSPITAL SUPERIOR | 3500 TOWER AVE SUPERIOR, WI 54880 | (715) 817-7000 | Critical Access Hospitals |
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1790765253, we treat the final digit (3) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 57. The final step is to find the difference between that total and the next multiple of ten (60 - 57 = 3).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 57 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
DULUTH, MN 55805
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1790765253, enumerated as an "individual" on January 20, 2006.
The provider is located at 407 E 3RD ST EH ST MARY'S MEDICAL CENTER DULUTH, MN 55805 and the phone number is (218) 786-4626.
Physician Assistant with taxonomy code 363A00000X.
The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield, Medica and. Please consult your insurance carrier or call the provider to verify.
Patrick Riley is affiliated with: ESSENTIA HEALTH ST MARY'S MEDICAL CENTER, ST CLAIR HOSPITAL and ST MARYS HOSPITAL SUPERIOR.
