MATTHEW JAMES NESPER MD NPI 1851372528
Radiology - Diagnostic Radiology in Oakland, CA
About MATTHEW JAMES NESPER MD
Matthew Nesper is a provider established in Oakland, California and his medical specialization is Radiology with a focus in diagnostic radiology with more than 43 years of experience. He graduated from Creighton University School Of Medicine in 1980. The NPI number of this provider is 1851372528 and was assigned on November 2005. The practitioner's primary taxonomy code is 2085R0202X with license number G45701 (CA). The provider is registered as an individual and his NPI record was last updated 12 years ago.
| NPI | 1851372528 |
| Provider Name | MATTHEW JAMES NESPER MD |
| Location Address | 411 30TH ST #508 OAKLAND, CA 94609 |
| Location Phone | (925) 274-4950 |
| Mailing Address | 411 30TH ST #508 OAKLAND, CA 94609 |
| Gender | Male |
| NPI Entity Type | Individual |
| Medical School Name | CREIGHTON UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 1980 |
| Is Sole Proprietor? | No |
| Enumeration Date | 11-09-2005 |
| Last Update Date | 12-22-2010 |
Matthew Nesper 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.
Matthew Nesper is registered with Medicare and accepts claims assignment, this means the provider accepts Medicare's approved amount for the cost of rendered services as full payment. Participating providers may not charge Medicare beneficiaries more than Medicare's approved amount for their services. Medicare beneficiaries still have to pay a coinsurance or copayment amount for a visit or service. According to Medicare claims data he has hospital affiliations with .
The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 33.9, 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 provider also has detailed performance information the following quality measures: implementation of improvements that contribute to more timely communication of test results, participation in an ahrq-listed patient safety organization., participation in joint commission evaluation initiative and use of qcdr data for ongoing practice assessment and improvements.
The typical physician office visit costs for Medicare beneficiaries in this area are: $26.51 for a new patient copayment and $21.68 for an established patient copayment.
Primary Taxonomy
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
| Taxonomy Code | 2085R0202X |
| Classification | Radiology |
| Type | Allopathic & Osteopathic Physicians |
| Specialization | Diagnostic Radiology |
| License No. | G45701 |
| License State | CA |
| Taxonomy Description | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
Accepted Insurance
The NPI profile data indicates this provider might be enrolled and accepting health plans from the following insurance companies or healthcare programs:
- Blue Cross Blue Shield
- Medicaid
- Medicare
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Business Address
411 30TH ST
#508
OAKLAND, CA
ZIP 94609
Phone: (925) 274-4950
Fax: (925) 274-4975
Mailing Address
411 30TH ST
#508
OAKLAND, CA
ZIP 94609
Phone: (925) 274-4950
Fax: (925) 274-4975
Location Map
PECOS Enrollment and Medicare Participation Status
What is PECOS?
PECOS is the Medicare Provider, Enrollment, Chain and Ownership System. PECOS is Medicare's enrollment and revalidation system and it is the primary source of information about verified Medicare professionals. A NPI number is necessary to register in PECOS. Providers must enroll in PECOS to avoid denied claims.
| Registered in PECOS? | Yes |
| PECOS PAC ID | 6103916390 |
| PECOS Enrollment ID | I20071211000771 |
| 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 order / refer Part B Clinical Laboratory and Imaging | Yes |
| Eligible order / refer Durable Medical Equipment | Yes |
| Eligible order / refer Home Health Agency (HHA) | Yes |
| Eligible order / refer Power Mobility Devices | Yes |
Physician Office Visit Costs
The provider accepts as payment the Medicare approved amount. Medicare beneficiaries should not be billed for more than the Medicare deductible and coinsurance amounts. Medicare pricing is usually a reference point for private insurance covered patients. The prices below reflect the costs for new and established patients in the 94609 ZIP code area.
| New Patients Office Visits Costs * | ||
|---|---|---|
| Most Utilized Procedure Code for new patients office visits: 99203 | ||
| Minimum New Patient Pricing | Maximum New Patient Pricing | Typical New Patient Pricing |
| $69.92 | $206.38 | $106.04 |
| Minimum New Patient Copayment | Maximum New Patient Copayment | Typical New Patient Copayment |
| $17.48 | $51.59 | $26.51 |
| Established Patients Office Visits Costs * | ||
|---|---|---|
| Most Utilized Procedure Code for established patients office visits: 99213 | ||
| Minimum Established Patient Pricing | Maximum Established Patient Pricing | Typical Established Patient Pricing |
| $22.97 | $169.96 | $86.73 |
| Minimum Established Patient Copayment | Maximum Established Patient Copayment | Typical Established Patient Copayment |
| $5.74 | $42.49 | $21.68 |
* The physician office visit costs information is obtained by Medicare's 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 Medicare's 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.
| MIPS Measure | Score Weight | Score | |
|---|---|---|---|
| Quality | 40% | 39.9 | |
|
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 (PI) | 25% | 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. |
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| Improvement Activities | 15% | 0 | |
|
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 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. |
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| Cost | 20% | 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. |
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| MIPS Final Score | - | 33.9 | |
| 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. | |||
MIPS Quality Measures
The following performance measures were reported under the Merit-Based Incentive Payment System (MIPS) and Qualified Clinical Data Registry (QCDR) quality measures program.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Implementation of improvements that contribute to more timely communication of test results | Yes | N/A |
| Timely communication of test results defined as timely identification of abnormal test results with timely follow-up. | ||
| Participation in an AHRQ-listed patient safety organization. | Yes | N/A |
| Participation in an AHRQ-listed patient safety organization. | ||
| Participation in Joint Commission Evaluation Initiative | Yes | N/A |
| Participation in Joint Commission Ongoing Professional Practice Evaluation initiative | ||
| Use of QCDR data for ongoing practice assessment and improvements | Yes | N/A |
| Participation in a Qualified Clinical Data Registry (QCDR) and use of QCDR data for ongoing practice assessment and improvements in patient safety, including:- Performance of activities that promote use of standard practices, tools and processes for quality improvement (for example, documented preventative screening and vaccinations that can be shared across MIPS eligible clinician or groups);- Use of standard questionnaires for assessing improvements in health disparities related to functional health status (for example, use of Seattle Angina Questionnaire, MD Anderson Symptom Inventory, and/or SF-12/VR-12 functional health status assessment);- Use of standardized processes for screening for social determinants of health such as food security, employment, and housing;- Use of supporting QCDR modules that can be incorporated into the certified EHR technology; or- Use of QCDR data for quality improvement such as comparative analysis across specific patient populations for adverse outcomes after an outpatient surgical procedure and corrective steps to address adverse outcomes. | ||
Clinician Utilization
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 2017. The reported codes are based on the top 5 codes for each available Medicare specialty, excluding evaluation and management codes.
- 1516X-ray of chest, 1 view, front (HCPCS:71010)
- 425X-ray of chest, 2 views, front and side (HCPCS:71020)
- 227CT scan of abdomen and pelvis with contrast (HCPCS:74177)
- 111Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck (HCPCS:93880)
- 106CT scan of abdomen and pelvis (HCPCS:74176)
- 84Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers (HCPCS:93971)
- 75X-ray of foot, minimum of 3 views (HCPCS:73630)
- 59X-ray of shoulder, minimum of 2 views (HCPCS:73030)
- 53X-ray of knee, 3 views (HCPCS:73562)
- 52X-ray of ribs of one side of body, minimum of 2 views (HCPCS:73510)
- 44Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers (HCPCS:93970)
- 22Ultrasound of head and neck (HCPCS:76536)
- 19X-ray of knee, 4 or more views (HCPCS:73564)
- 17X-ray of hand, minimum of 3 views (HCPCS:73130)
- 17Radiological supervision and interpretation of CT guidance for needle insertion (HCPCS:77012)
- 16Nuclear medicine study of vessels of heart using drugs or exercise multiple studies (HCPCS:78452)
- 15X-ray of abdomen, single view (HCPCS:74000)
- 14X-ray of wrist, minimum of 3 views (HCPCS:73110)
Additional Identifiers
Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 00G457010 | MEDICAID (05) | CA | |
| 00G457013 | MEDICARE PIN (08) | CA | |
| CG931 | MEDICARE PIN (08) | CA | |
| 00G457011 | MEDICARE ID-TYPE UNSPECIFIED (04) | CA | |
| A50153 | MEDICARE UPIN (02) | ||
| 00G457010 | OTHER (01) | CA | BLUE SHIELD |
| 00G457015 | MEDICARE PIN (08) | CA |
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 | 5 | 1 | 3 | 7 | 2 | 5 | 2 | 8 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 8 | 10 | 1 | 6 | 7 | 4 | 5 | 4 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 8 + 1 + 0 + 1 + 6 + 7 + 4 + 5 + 4 + 24 = 62 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 62 = 8 | 8 | ||||||||
The NPI number 1851372528 is valid because the calculated check digit 8 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 |
|---|---|---|---|
| 1467445767 | DR. EDWARD DRASIN M.D. Individual | Radiology (Diagnostic Radiology) | 411 30TH ST #508 OAKLAND, CA 94609 (925) 274-4950 |
| 1790778728 | DR. STEPHEN J. KAHN M.D. Individual | Radiology (Diagnostic Radiology) | 411 30TH ST #508 OAKLAND, CA 94609 (925) 274-4950 |
| 1487648853 | DR. HAYDEN O. EVANS M.D. Individual | Radiology (Diagnostic Radiology) | 411 30TH ST #508 OAKLAND, CA 94609 (925) 274-4950 |
| 1972597458 | DR. YURIRIA S. LOBATO MD Individual | Radiology (Diagnostic Radiology) | 411 30TH ST #508 OAKLAND, CA 94609 (925) 274-4950 |
| 1982698452 | DR. RICHARD J. KEENE MD Individual | Radiology (Diagnostic Radiology) | 411 30TH ST #508 OAKLAND, CA 94609 (925) 274-4950 |
| 1295720704 | DR. DOUGLAS C. RIEHLE MD Individual | Radiology (Diagnostic Radiology) | 411 30TH ST #508 OAKLAND, CA 94609 (925) 274-4950 |
| 1588659882 | DR. MICHAEL MAIMAN MD Individual | Radiology (Diagnostic Radiology) | 411 30TH ST #508 OAKLAND, CA 94609 (925) 274-4950 |
| 1144215955 | DR. PATRICK J PERKINS MD Individual | Radiology (Diagnostic Radiology) | 411 30TH ST #508 OAKLAND, CA 94609 (925) 274-4950 |
| 1538155841 | DR. HUMPHREY STUART MANSFIELD MD Individual | Radiology (Diagnostic Radiology) | 411 30TH ST #508 OAKLAND, CA 94609 (925) 274-4950 |
| 1609867894 | MRS. PATRICIA A WALKER DDS Individual | Dentist (General Practice) | 411 30TH ST STE 414 OAKLAND, CA 94609 (510) 465-9111 |
| 1265480099 | PACIFIC IMAGING CONSULTANTS, A MEDICAL GROUP, INC. Organization | Radiology (Diagnostic Radiology) | 411 30TH ST #508 OAKLAND, CA 94609 (925) 274-4950 |
| 1376643254 | WADE R CARTWRIGHT MD Individual | Otolaryngology | 411 30TH ST # 401 OAKLAND, CA 94609 (510) 834-6642 |
| 1205924701 | DR. MOREY ABRAM WEINGARTEN MD Individual | Psychiatry & Neurology (Psychiatry) | 411 30TH ST SUITE 412 OAKLAND, CA 94609 (510) 836-2757 |
| 1396829867 | DR. AIMEE MCKINNEY PORTER D.C. Individual | Chiropractor | 411 30TH ST SUITE 304 OAKLAND, CA 94609 (510) 444-2772 |
| 1356413983 | LORENZO PUERTAS JR. L.AC. Individual | Acupuncturist | 411 30TH ST SUITE 304 OAKLAND, CA 94609 (510) 444-2772 |
| 1639225444 | DR. CHRISTOPHER MICHAEL SUE M.D. Individual | Psychiatry & Neurology (Psychiatry) | 411 30TH ST SUITE 314 OAKLAND, CA 94609 (510) 273-4200 |
| 1356549620 | ESTHER ELISABETH JONES Individual | Counselor | 411 30TH ST # 314 OAKLAND, CA 94609 (510) 273-4200 |
| 1437349255 | JAMES JORDAN Individual | Counselor | 411 30TH ST #314 OAKLAND, CA 94609 (510) 273-4200 |
| 1003006362 | MICHELE MABRY WILSON Individual | Counselor | 411 30TH ST #314 OAKLAND, CA 94609 (510) 273-4200 |
| 1679761597 | CAROLINE SAMIEZADE-YAZD Individual | Religious Nonmedical Nursing Personnel | 411 30TH ST #314 OAKLAND, CA 94609 (510) 273-4200 |
Frequently Asked Questions
What is Matthew Nesper MD NPI number?
The NPI number assigned to this healthcare provider is 1851372528, registered as an "individual" on November 09, 2005
Where is Matthew Nesper MD located?
The provider is located at 411 30th St #508 Oakland, Ca 94609 and the phone number is (925) 274-4950
Which is Matthew Nesper MD specialty?
The provider's speciality is Radiology with a focus in Diagnostic Radiology
How many years of experience does Matthew Nesper MD have?
The provider has more than 43 years of experience. He graduated from Creighton University School Of Medicine in 1980.
What insurance does Matthew Nesper MD accept?
The provider might be accepting Blue Cross Blue Shield, Medicaid and Medicare. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Is Matthew Nesper MD registered in PECOS?
Yes, as of May 11, 2023 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a Medicare 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.
How much is a visit to Matthew Nesper MD?
Medicare beneficiaries should expect a typical cost of $106.04 with an average copayment of $26.51 for new patient appointments. Established patients should expect a typical charge of $86.73 and an average copayment of 21.68. Please review your insurance plan or contact the provider directly to determine your specific costs.
What are some of the services provided by Matthew Nesper MD?
The most common procedures or services performed by this practitioner are: X-ray of chest, 1 view, front, X-ray of chest, 2 views, front and side, CT scan of abdomen and pelvis with contrast, Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck, CT scan of abdomen and pelvis, Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers, X-ray of foot, minimum of 3 views, X-ray of shoulder, minimum of 2 views, X-ray of knee, 3 views, X-ray of ribs of one side of body, minimum of 2 views, Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers, Ultrasound of head and neck, X-ray of knee, 4 or more views, X-ray of hand, minimum of 3 views, Radiological supervision and interpretation of CT guidance for needle insertion, Nuclear medicine study of vessels of heart using drugs or exercise multiple studies, X-ray of abdomen, single view and X-ray of wrist, minimum of 3 views.
How do I update my NPI information?
The NPI record of Matthew Nesper MD was last updated on November 09, 2005. 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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