DR. MATTHEW MICHAEL KOEHLER DO
NPI 1801090519
Dermatology in San Rafael, CA

Quality Rating: 75 out of 100 score

NPI Status: Active since June 14, 2007

Contact Information

5000 CIVIC CENTER DR
SAN RAFAEL, CA
ZIP 94903
Phone: (415) 499-0100

Get Directions Write a Review

Table of Contents

NPI Profile Information
Primary Taxonomy
Secondary Taxonomies
Medicare Participation & PECOS Status
Areas of Expertise
Physician Visit Costs
Overall Quality Performance
Quality Reporting
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Male
Years of Experience 19
Dermatology
May Accept Medicare Approved Payment
PECOS Enrolled
Medicare Quality Reporting

About MATTHEW KOEHLER

This page provides the complete NPI Profile along with additional information for Matthew Koehler, a provider established in San Rafael, California with a medical specialization in Dermatology and more than 19 years of experience. The healthcare provider is registered in the NPI registry with number 1801090519 assigned on June 2007. The practitioner's primary taxonomy code is 207N00000X with license number 10685 (CA). The provider is registered as an individual and his NPI record was last updated 5 years ago.

NPI: 1801090519
Provider Name: DR. MATTHEW MICHAEL KOEHLER DO
Gender: Male
Entity Type: Individual
Location Address: 5000 CIVIC CENTER DR SAN RAFAEL, CA 94903
Location Phone: (415) 499-0100
Mailing Address: 5000 CIVIC CENTER DR SAN RAFAEL, CA 94903
Mailing Phone: (415) 499-0100
Medical School Name: OTHER
Graduation Year: 2007
Is Sole Proprietor?: No
Enumeration Date: 06-14-2007
Last Update Date: 08-20-2020
Code Navigator

A dermatologist like Matthew Koehler is a medical specialty involving the management of skin conditions and diseases. Dermatologists diagnose some sexually transmitted diseases, warts, cancer, acne, dermatitis and may offer cosmetic treatments, and therapies that reduce age spots and wrinkles.

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: Dermatology
Taxonomy Code: 207N00000X
Type: Allopathic & Osteopathic Physicians
License No.: 10685
License State: CA
Taxonomy Description: A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

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	390200000X	Student, Health Care	Student in an Organized Health Care Education/Training Program

Medicare Participation & PECOS Enrollment Status

Matthew Koehler is registered with Medicare but maybe doesn't accept claims assignment. If you are a Medicare beneficiary call and confirm with the provider before seeking any services.

Matthew Koehler 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: 7416243159
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: I20160907001163
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? Maybe
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.

Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)
Biopsy of related skin growth, each additional growth
Biopsy of related skin growth, first growth
Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm
Destruction of precancer skin growth, 1 growth
Destruction of precancer skin growth, 15 or more growths
Destruction of precancer skin growth, 2-14 growths
Destruction of skin growth, 1-14 growths
Established patient office or other outpatient visit, 10-19 minutes
Established patient office or other outpatient visit, 20-29 minutes
Established patient office or other outpatient visit, 30-39 minutes
Injection into skin growth, 1-7 growths
Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.6-5.0 cm
Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm
Melanoma (skin cancer) excision
New patient office or other outpatient visit, 30-44 minutes
Pathology examination of tissue using a microscope, intermediate complexity
Punch biopsy, first skin growth
Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm
Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm
Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm
Shaving of skin growth of body, arms, or legs, 0.5 cm or less
Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm
Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm
Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm
Simple or single drainage of skin abscess

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 94903 ZIP code area.

New Patients Visit Costs *

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

Average New Patient Price $104.67
Minimum New Patient Price $69.07
Maximum New Patient Price $202.63

Average New Patient Copayment $26.16
Minimum New Patient Copayment $17.26
Maximum New Patient Copayment $50.65

Established Patients Visit Costs *

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

Average Established Patient Price $85
Minimum Established Patient Price $23.44
Maximum Established Patient Price $166.64

Average Established Patient Copayment $21.25
Minimum Established Patient Copayment $5.86
Maximum Established Patient Copayment $41.66

* 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 75, 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: 75 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: N/A

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: N/A

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: N/A

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 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
Biopsy Follow-Up	100%	244
Percentage of new patients whose biopsy results have been reviewed and communicated to the primary care/referring physician and patient by the performing physician
Documentation of Current Medications in the Medical Record	44%	3729
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	99%	4272
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.
Implementation of Use of Specialist Reports Back to Referring Clinician or Group to Close Referral Loop	Yes	N/A
Performance of regular practices that include providing specialist reports back to the referring individual MIPS eligible clinician or group to close the referral loop or where the referring individual MIPS eligible clinician or group initiates regular inquiries to specialist for specialist reports which could be documented or noted in the EHR technology.
Improved Practices that Disseminate Appropriate Self-Management Materials	Yes	N/A
Provide self-management materials at an appropriate literacy level and in an appropriate language.
Medication Reconciliation	25%	1506
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	77%	3697
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	58%	848
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
Provide Patient Access	67%	3697
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	1%	3697
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.

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	8	0	1	0	9	0	5	1	9
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	8	0	1	0	9	0	5	2
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 8 + 0 + 1 + 0 + 9 + 0 + 5 + 2 + 24 = 51
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 51 = 9									9

The NPI number 1801090519 is valid because the calculated check digit 9 using the Luhn validation algorithm matches the last digit of the original NPI number.