DONNA BLOODWORTH MD
NPI 1811077241
Physical Medicine & Rehabilitation in Houston, TX
Quality Rating: 100 out of 100 score
NPI Status: Active since October 17, 2006
Contact Information
6620 MAIN ST
HOUSTON, TX
ZIP 77030
Phone: (713) 798-6198
Fax: (713) 798-4688
- Individual
- Female
- Years of Experience 36
- Physical Medicine & Rehabilitation
- PECOS Enrolled
- Accepts Medicare Approved Payment
About DONNA BLOODWORTH
Donna Bloodworth is a provider established in Houston, Texas and her medical specialization is Physical Medicine & Rehabilitation with more than 36 years of experience. She graduated from Virginia Commonwealth University, School Of Medicine in 1988. The healthcare provider is registered in the NPI registry with number 1811077241 assigned on October 2006. The practitioner's primary taxonomy code is 208100000X with license number J3599 (TX). The provider is registered as an individual and her NPI record was last updated 16 years ago.
- NPI
- 1811077241
- Provider Name
- DONNA BLOODWORTH MD
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 6620 MAIN ST HOUSTON, TX 77030
- Location Phone
- (713) 798-6198
- Location Fax
- (713) 798-4688
- Mailing Address
- 6620 MAIN ST HOUSTON, TX 77030
- Mailing Phone
- (713) 798-6198
- Mailing Fax
- (713) 798-4688
- Medical School Name
- VIRGINIA COMMONWEALTH UNIVERSITY, SCHOOL OF MEDICINE
- Graduation Year
- 1988
- Is Sole Proprietor?
- No
- Enumeration Date
- 10-17-2006
- Last Update Date
- 01-31-2008
- Code Navigator
Donna Bloodworth 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 provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 100, 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
Physical Medicine & Rehabilitation
- Taxonomy Code
- 208100000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- J3599
- License State
- TX
- Taxonomy Description
- Physical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and treating patients with physical disabilities. These disabilities may arise from conditions affecting the musculoskeletal system such as neck and back pain, sports injuries, or other painful conditions affecting the limbs, such as carpal tunnel syndrome. Alternatively, the disabilities may result from neurological trauma or disease such as spinal cord injury, head injury or stroke. A physician certified in physical medicine and rehabilitation is often called a physiatrist. The primary goal of the physiatrist is to achieve maximal restoration of physical, psychological, social and vocational function through comprehensive rehabilitation. Pain management is often an important part of the role of the physiatrist. For diagnosis and evaluation, a physiatrist may include the techniques of electromyography to supplement the standard history, physical, x-ray and laboratory examinations. The physiatrist has expertise in the appropriate use of therapeutic exercise, prosthetics (artificial limbs), orthotics and mechanical and electrical devices.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Aetna CVS Health
- Gold 3: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 - HMO
- Gold 4: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 - HMO
- Gold S: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 - HMO
- Silver 1: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 - HMO
- Silver 5: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 - HMO
- Silver 6: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 - HMO
- Silver 7: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 - HMO
- Silver S: Aetna network of doctors & hospitals + $0 walk-in clinic + $0 Virtual Care options 24/7 - HMO
Blue Cross and Blue Shield of Texas
- Blue Advantage Bronze HMO℠ 204 - HMO
- Blue Advantage Bronze HMO℠ 301 - HMO
- Blue Advantage Bronze HMO℠ 302 - HMO
- Blue Advantage Bronze HMO℠ 707 - HMO
- Blue Advantage Gold HMO℠ 206 - HMO
- Blue Advantage Gold HMO℠ 603 - HMO
- Blue Advantage Gold HMO℠ 706 - HMO
- Blue Advantage Plus Bronze℠ 303 - POS
- Blue Advantage Plus Bronze℠ 305 - POS
- Blue Advantage Plus Bronze℠ 707 - POS
Community Health Choice
- Community Premier Bronze 003 (No deductible for PCP, Free Preventive Care, 24/7 Telehealth) - HMO
- Community Premier Bronze 018 (No deductible for PCP, Specialists & Generics, Free 24/7 Telehealth) - HMO
- Community Premier Gold 005 (No Deductible for PCP, Specialists & Generics, Free 24/7 Telehealth) - HMO
- Community Premier Gold 021 (No Deductible for PCP, Specialists & Generics, Free 24/7 Telehealth) - HMO
- Community Premier Silver 004 (No deductible for PCP, Specialists, Urgent Care & Generics, Free 24/7 Telehealth) - HMO
- Community Premier Silver 012 (No deductible for PCP, Urgent Care & Generics, Free 24/7 Telehealth) - HMO
- Community Premier Silver 013 (No deductible for PCP, Specialists, Urgent Care & Generics, Free 24/7 Telehealth) - HMO
- Community Premier Silver 020 (No Deductible for PCP, Specialists & Generics, Free 24/7 Telehealth) - HMO
- Community Premier Virtual Bronze 011 (Unlimited Free 24/7 Virtual Visits) - HMO
- Community Select Bronze 016 (No deductible for PCP & Generics, Free 24/7 Telehealth) - HMO
Molina Healthcare
- Gold 1 - HMO
- Gold 1 with Adult Vision Services - HMO
- Gold 8 - HMO
- Silver 1 250 - HMO
- Silver 1 250 with Adult Vision Services - HMO
- Silver 12 250 with First 4 Primary Care Visits Free - HMO
- Silver 3 250 - HMO
- Silver 8 250 - HMO
UnitedHealthcare
- UHC Bronze Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx, $0 Insulin) (Disponible en espanol) - HMO
- UHC Gold Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx, $0 Insulin) (Disponible en espanol) - HMO
- UHC Silver Virtual First (Unlimited $0 App-based Care, $3 Tier 2 Rx, $0 Insulin) (Disponible en espanol) - HMO
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 |
---|---|---|---|
P00028960 | MEDICARE PIN (08) | TX | |
85X623 | MEDICARE PIN (08) | TX | |
87W994 | MEDICARE PIN (08) | TX | |
F43097 | MEDICARE UPIN (02) |
PECOS Enrollment and Medicare Participation Status
Donna Bloodworth 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: 7012105851
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: I20101221000848
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.
Prosthetic and Orthotic Devices
Prosthetic/Orthotic devices (D1F)
Prosthetic sock, multiple ply, below knee, each (HCPCS:L8420)
2 DME suppliers used 11 Medicare Claims 84 Services Paid
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.
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Final Score: 100 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.
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Quality Score: 100
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.
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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.
Hospital Affiliations
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. Donna Bloodworth is affiliated with the following medical facilities:
Hospital Name | Address | Phone | Hospital Type | Overall Rating |
---|---|---|---|---|
HARRIS HEALTH SYSTEM | 2525 HOLLY HALL HOUSTON, TX 77054 | (713) 566-6417 | Acute Care Hospitals |
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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. | |||||||||
1 | 8 | 1 | 1 | 0 | 7 | 7 | 2 | 4 | 1 |
Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
2 | 8 | 2 | 1 | 0 | 7 | 14 | 2 | 8 | |
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
2 + 8 + 2 + 1 + 0 + 7 + 1 + 4 + 2 + 8 + 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 1811077241 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.
NPI | Name / Type | Taxonomy | Address |
---|---|---|---|
1215930276 | TEXAS INTERNATIONAL ENDOSCOPY CENTER, LP Organization | Clinic/Center (Ambulatory Surgical) | 6620 MAIN ST STE 1500 HOUSTON, TX 77030 (713) 520-8432 |
1497757611 | PATRICIA A SMITH M.D. Individual | Obstetrics & Gynecology | 6620 MAIN ST STE 1450 HOUSTON, TX 77030 (713) 798-7500 |
1669474359 | WILLIAM EDWARD GIBBONS M.D. Individual | Obstetrics & Gynecology (Reproductive Endocrinology) | 6620 MAIN ST SUITE 1450 HOUSTON, TX 77030 (713) 798-7500 |
1235110990 | MRS. JENNIFER L LEMOINE M.S. Individual | Genetic Counselor, MS | 6620 MAIN ST SUITE 1450 HOUSTON, TX 77030 (713) 798-7250 |
1881665354 | CARL F GIESLER MD Individual | Obstetrics & Gynecology (Gynecology) | 6620 MAIN ST STE 1450 HOUSTON, TX 77030 (713) 798-7500 |
1417916776 | ANN I SCHUTT AINE MD Individual | Obstetrics & Gynecology | 6620 MAIN ST SUITE 1450 HOUSTON, TX 77030 (713) 798-7500 |
1114979309 | KWAI-TUNG CHAN M.D. Individual | Physical Medicine & Rehabilitation (Pain Medicine) | 6620 MAIN ST SUITE #1350 HOUSTON, TX 77030 (713) 798-6198 |
1942256797 | DANIEL YOSHOR M.D. Individual | Neurological Surgery | 6620 MAIN ST 13TH FLOOR HOUSTON, TX 77030 (713) 798-4696 |
1104863141 | DR. AIMEE DINORAH GARCIA M.D. Individual | Internal Medicine (Geriatric Medicine) | 6620 MAIN ST HOUSTON, TX 77030 (713) 798-2500 |
1457399776 | CAROL Y CHIANG M.D. Individual | Radiology (Diagnostic Radiology) | 6620 MAIN ST HOUSTON, TX 77030 (713) 798-2300 |
1710926498 | SEAN MAX ROSENBAUM M.D. Individual | Obstetrics & Gynecology | 6620 MAIN ST SUITE 1450 HOUSTON, TX 77030 (713) 798-7500 |
1104867175 | BAYLOR COLLEGE OF MEDICINE Organization | Internal Medicine | 6620 MAIN ST HOUSTON, TX 77030 (713) 798-2500 |
1225072291 | BAYLOR COLLEGE OF MEDICINE Organization | Surgery | 6620 MAIN ST STE 1475 HOUSTON, TX 77030 (713) 798-5700 |
1922036425 | JAMES K WILSON A.T.C., L.A.T. Individual | Specialist/Technologist (Athletic Trainer) | 6620 MAIN ST 13TH FLOOR HOUSTON, TX 77030 (713) 986-5595 |
1134152697 | YOUSSEF G COMAIR M.D. Individual | Neurological Surgery | 6620 MAIN ST SUITE 1350 HOUSTON, TX 77030 (713) 798-4696 |
1114944733 | BAYLOR COLLEGE OF MEDICINE Organization | Urology | 6620 MAIN ST SUITE 1325 HOUSTON, TX 77030 (713) 798-4001 |
1639191133 | GEORGE CLIFFORD GABEL JR. PA-C Individual | Physician Assistant | 6620 MAIN ST HOUSTON, TX 77030 (713) 798-1510 |
1164446928 | MRS. LYNNE W SCOTT LD Individual | Dietitian, Registered | 6620 MAIN ST HOUSTON, TX 77030 (713) 798-3334 |
1982628582 | DEBORAH ANN BLACKSHIRE PA-C Individual | Physician Assistant (Surgical) | 6620 MAIN ST HOUSTON, TX 77030 (713) 798-5700 |
1972516557 | BAYLOR COLLEGE OF MEDICINE Organization | Obstetrics & Gynecology | 6620 MAIN ST SUITE 1450 HOUSTON, TX 77030 (713) 798-7500 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1811077241, enumerated in the NPI registry as an "individual" on October 17, 2006
The provider is located at 6620 Main St Houston, Tx 77030 and the phone number is (713) 798-6198
The provider's speciality is Physical Medicine & Rehabilitation with taxonomy code 208100000X
The provider has more than 36 years of experience. She graduated from Virginia Commonwealth University, School Of Medicine in 1988.
The provider might be accepting Accepts: Aetna CVS Health, Blue Cross and Blue Shield of. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of May 17, 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: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
The provider has an overall high rating in the following quality measures: quality clinical practices and patient outcomes and experiences.
The practitioner is affiliated to the following hospital(s): HARRIS HEALTH SYSTEM. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
This NPI record was last updated on October 17, 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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