DR. DOUGLAS J. MARTIN MD
NPI 1821037003
Radiology - Diagnostic Radiology in Lewisberry, PA

NPI Status: Active since June 05, 2006

Contact Information

629 D LOWTHER ROAD
LEWISBERRY, PA
ZIP 17339
Phone: (717) 932-5200
Fax: (717) 932-3095

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  • Individual
  • Male
  • Years of Experience 23
  • Radiology
  • Diagnostic Radiology
  • PECOS Enrolled
  • Accepts Medicare Approved Payment

About DOUGLAS MARTIN

Douglas Martin is a provider established in Lewisberry, Pennsylvania and his medical specialization is Radiology with a focus in diagnostic radiology with more than 23 years of experience. He graduated from New York University School Of Medicine in 2001. The healthcare provider is registered in the NPI registry with number 1821037003 assigned on June 2006. The practitioner's primary taxonomy code is 2085R0202X with license number MD429037 (PA). The provider is registered as an individual and his NPI record was last updated 12 years ago.

NPI
1821037003
Provider Name
DR. DOUGLAS J. MARTIN MD
Gender
Male
Entity Type
Individual
Location Address
629 D LOWTHER ROAD LEWISBERRY, PA 17339
Location Phone
(717) 932-5200
Location Fax
(717) 932-3095
Mailing Address
629 D LOWTHER RD LEWISBERRY, PA 17339
Mailing Phone
(717) 932-5200
Mailing Fax
(717) 932-3095
Medical School Name
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
Graduation Year
2001
Is Sole Proprietor?
No
Enumeration Date
06-05-2006
Last Update Date
01-18-2012
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Douglas Martin 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: $21.99 for a new patient copayment and $17.88 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

Radiology Diagnostic Radiology

Taxonomy Code
2085R0202X
Type
Allopathic & Osteopathic Physicians
License No.
MD429037
License State
PA
Taxonomy Description
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat 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
101626188027MEDICAID (05)PA 
410751900MEDICAID (05)MD 
I57376MEDICARE UPIN (02) 
102796HEZMEDICARE PIN (08) 

PECOS Enrollment and Medicare Participation Status

Douglas Martin 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: 3274536149

    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: I20060814000478

    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

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 17339 ZIP code area.

New Patients Visit Costs *

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

  • Average New Patient Price $87.96
  • Minimum New Patient Price $57.02
  • Maximum New Patient Price $174.05
  • Average New Patient Copayment $21.99
  • Minimum New Patient Copayment $14.25
  • Maximum New Patient Copayment $43.51

Established Patients Visit Costs *

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

  • Average Established Patient Price $71.53
  • Minimum Established Patient Price $17.59
  • Maximum Established Patient Price $142.08
  • Average Established Patient Copayment $17.88
  • Minimum Established Patient Copayment $4.39
  • Maximum Established Patient Copayment $35.52

* 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.

  • 915

    Mammography of both breasts (HCPCS:77067)

  • 274

    Ct scan head or brain (HCPCS:70450)

  • 237

    X-ray of chest, 1 view (HCPCS:71045)

  • 169

    Ct scan of abdomen and pelvis with contrast (HCPCS:74177)

  • 148

    X-ray of chest, 2 views (HCPCS:71046)

  • 88

    Ct scan chest (HCPCS:71250)

  • 84

    Ct scan of abdomen and pelvis (HCPCS:74176)

  • 23

    X-ray of hip with pelvis, 2-3 views (HCPCS:73502)

  • 16

    X-ray of knee, 4 or more views (HCPCS:73564)

  • 15

    X-ray of shoulder, minimum of 2 views (HCPCS:73030)

  • 14

    X-ray of hand, minimum of 3 views (HCPCS:73130)

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. Douglas Martin is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
READING HOSPITAL420 S 5TH AVENUE
WEST READING, PA 19611
(610) 988-8000Acute 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.
1821037003
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2841031400
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 8 + 4 + 1 + 0 + 3 + 1 + 4 + 0 + 0 + 24 = 47
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
50 - 47 = 33

The NPI number 1821037003 is valid because the calculated check digit 3 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1578781860DR. SARAH H SHIPLEY MD
Individual
Radiology (Diagnostic Radiology)629 D LOWTHER ROAD
LEWISBERRY, PA 17339
(717) 932-5200

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1821037003, enumerated in the NPI registry as an "individual" on June 05, 2006

The provider is located at 629 D Lowther Road Lewisberry, Pa 17339 and the phone number is (717) 932-5200

The provider's speciality is Radiology with taxonomy code 2085R0202X with a focus in Diagnostic Radiology

The provider has more than 23 years of experience. He graduated from New York University School Of Medicine in 2001.

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 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.

Medicare beneficiaries should expect a typical cost of $87.96 with an average copayment of $21.99 for new patient appointments. Established patients should expect a typical charge of $71.53 and an average copayment of 17.88. 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: Mammography of both breasts, Ct scan head or brain, X-ray of chest, 1 view, Ct scan of abdomen and pelvis with contrast, X-ray of chest, 2 views, Ct scan chest, Ct scan of abdomen and pelvis, X-ray of hip with pelvis, 2-3 views, X-ray of knee, 4 or more views, X-ray of shoulder, minimum of 2 views and X-ray of hand, minimum of 3 views.

The practitioner is affiliated to the following hospital(s): READING HOSPITAL. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

This NPI record was last updated on June 05, 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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