DR. RUSSELL HOWARD HJELMSTAD MD
NPI 1801818489
Pathology - Anatomic Pathology & Clinical Pathology in Traverse City, MI


Quality Rating: 87.25 out of 100 score

NPI Status: Active since July 24, 2006

Contact Information

1105 6TH ST
TRAVERSE CITY, MI
ZIP 49684
Phone: (231) 935-0499

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  • Individual
  • Male
  • Pathology
  • Anatomic Pathology & Clinical Pathology
  • PECOS Enrolled

About RUSSELL HJELMSTAD

Russell Hjelmstad is a provider established in Traverse City, Michigan and his medical specialization is Pathology with a focus in anatomic pathology & clinical pathology . The healthcare provider is registered in the NPI registry with number 1801818489 assigned on July 2006. The practitioner's primary taxonomy code is 207ZP0102X with license number 4301060645 (MI). The provider is registered as an individual and his NPI record was last updated 17 years ago.

NPI
1801818489
Provider Name
DR. RUSSELL HOWARD HJELMSTAD MD
Gender
Male
Entity Type
Individual
Location Address
1105 6TH ST TRAVERSE CITY, MI 49684
Location Phone
(231) 935-0499
Mailing Address
1105 6TH ST TRAVERSE CITY, MI 49684
Mailing Phone
(231) 935-0499
Is Sole Proprietor?
No
Enumeration Date
07-24-2006
Last Update Date
10-09-2007
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The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 87.25, 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.

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

Pathology Anatomic Pathology & Clinical Pathology

Taxonomy Code
207ZP0102X
Type
Allopathic & Osteopathic Physicians
License No.
4301060645
License State
MI
Taxonomy Description
A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.

Insurance Plans Accepted

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

  • Medicare

  • Medicaid


*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
F52685MEDICARE UPIN (02)MI 
2918219MEDICAID (05)MI 

PECOS Enrollment and Medicare Participation Status

Russell Hjelmstad 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: Durable Medical Equipment (DME) 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

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: No

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): No

  • Eligible to Order or Refer Power Mobility Devices: Yes

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 49684 ZIP code area.

New Patients Visit Costs *

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

  • Average New Patient Price $130.74
  • Minimum New Patient Price $56.39
  • Maximum New Patient Price $172.8
  • Average New Patient Copayment $32.68
  • Minimum New Patient Copayment $14.09
  • Maximum New Patient Copayment $43.2

Established Patients Visit Costs *

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

  • Average Established Patient Price $100.65
  • Minimum Established Patient Price $17.24
  • Maximum Established Patient Price $140.86
  • Average Established Patient Copayment $25.16
  • Minimum Established Patient Copayment $4.31
  • Maximum Established Patient Copayment $35.21

* 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: 87.25 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

    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: 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.

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.

  • 1055

    Pathology examination of tissue using a microscope, intermediate complexity (HCPCS:88305)

  • 101

    Pathology examination of tissue using a microscope, moderately high complexity (HCPCS:88307)

  • 79

    Special stained specimen slides to examine tissue (HCPCS:88341)

  • 55

    Tissue or cell analysis by immunologic technique (HCPCS:88342)

  • 27

    Pathology examination of tissue using a microscope, moderately low complexity (HCPCS:88304)

Reviews for DR. RUSSELL HOWARD HJELMSTAD MD

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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.
1801818489
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
280116116416
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 8 + 0 + 1 + 1 + 6 + 1 + 1 + 6 + 4 + 1 + 6 + 24 = 61
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 61 = 99

The NPI number 1801818489 is valid because the calculated check digit 9 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.

NPI Name / Type Taxonomy Address
1548265911DR. TROY W AHLSTROM M.D.
Individual
Internal Medicine1105 6TH ST
TRAVERSE CITY, MI 49684
(231) 947-0673
1336144740DR. ROBERT F SIGWORTH M.D.
Individual
Internal Medicine1105 6TH ST
TRAVERSE CITY, MI 49684
(231) 947-0673
1720083108DR. DAVID A FRIAR M.D.
Individual
Internal Medicine1105 6TH ST
TRAVERSE CITY, MI 49684
(231) 947-0673
1427053529 NATALIE S BROWN M.D., PHD
Individual
Internal Medicine1105 6TH ST
TRAVERSE CITY, MI 49684
(231) 947-0673
1730184847DR. KENNETH W FRIAR M.D.
Individual
Internal Medicine1105 6TH ST
TRAVERSE CITY, MI 49684
(231) 947-0673
1720083801 KURT O CROSBY PA
Individual
Physician Assistant (Medical)1105 6TH ST
TRAVERSE CITY, MI 49684
(231) 947-0673
1518962604 VINCENT G WORTHINGTON NP
Individual
Nurse Practitioner1105 6TH ST
TRAVERSE CITY, MI 49684
(231) 947-0673
1487659165 MICHAEL R HOWARD PA
Individual
Physician Assistant (Medical)1105 6TH ST
TRAVERSE CITY, MI 49684
(231) 947-0673
1629073309 JAMES W LEVY PA
Individual
Physician Assistant (Medical)1105 6TH ST
TRAVERSE CITY, MI 49684
(231) 947-0673
1225034762 CURT M MIKULSKI M.D.
Individual
Emergency Medicine (Emergency Medical Services)1105 6TH ST
TRAVERSE CITY, MI 49684
(231) 947-0673
1437155983 BRENDA L SNYDER M.D.
Individual
Emergency Medicine (Emergency Medical Services)1105 6TH ST
TRAVERSE CITY, MI 49684
(231) 947-0673
1407852965 ERIC VANDERHAAGEN D.O.
Individual
Emergency Medicine (Emergency Medical Services)1105 6TH ST
TRAVERSE CITY, MI 49684
(231) 947-0673
1053316588 DALE C BLUM M.D.
Individual
Emergency Medicine (Emergency Medical Services)1105 6TH ST
TRAVERSE CITY, MI 49684
(231) 947-0673
1548268808 DAVID S SCIAMANNA DO
Individual
Pediatrics (Neonatal-Perinatal Medicine)1105 6TH ST MUNSON MEDICAL CTR-NICU
TRAVERSE CITY, MI 49684
(231) 935-5544
1013966506TRAVERSE ANESTHESIA ASSOCIATES, PC
Organization
Anesthesiology (Pain Medicine)1105 6TH ST MUNSON MEDICAL CENTER/TRAVERSE ANESTHESIA ASSOCIATES, P
TRAVERSE CITY, MI 49684
(231) 935-5770
1689615155 DOUGLAS S COFFIN PA-C
Individual
Physician Assistant (Medical)1105 6TH ST
TRAVERSE CITY, MI 49684
(231) 947-0673
1477581759MUNSON MEDICAL CENTER
Organization
Nurse Practitioner1105 6TH ST
TRAVERSE CITY, MI 49684
(231) 935-5000
1205851714 JUHN MARK HAN
Individual
Emergency Medicine1105 6TH ST
TRAVERSE CITY, MI 49684
(231) 947-0673
1417976036 MARCELLA SPENCE FNP
Individual
Nurse Practitioner1105 6TH ST
TRAVERSE CITY, MI 49684
(231) 935-5000
1114941903DR. PHILIP LEE PERKINS MD
Individual
Pathology (Anatomic Pathology & Clinical Pathology)1105 6TH ST
TRAVERSE CITY, MI 49684
(231) 935-0499

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1801818489, enumerated in the NPI registry as an "individual" on July 24, 2006

The provider is located at 1105 6th St Traverse City, Mi 49684 and the phone number is (231) 935-0499

The provider's speciality is Pathology with taxonomy code 207ZP0102X with a focus in Anatomic Pathology & Clinical Pathology

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Yes, as of June 14, 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: Durable Medical Equipment (DME) and Power Mobility Devices.

The provider has an overall high rating in the following quality measures: quality clinical practices and patient outcomes and experiences.

Medicare beneficiaries should expect a typical cost of $130.74 with an average copayment of $32.68 for new patient appointments. Established patients should expect a typical charge of $100.65 and an average copayment of 25.16. 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: Pathology examination of tissue using a microscope, intermediate complexity, Pathology examination of tissue using a microscope, moderately high complexity, Special stained specimen slides to examine tissue, Tissue or cell analysis by immunologic technique and Pathology examination of tissue using a microscope, moderately low complexity.

This NPI record was last updated on July 24, 2006. 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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