CLAUDIA ANTONIETA NIEVES PRADO M.D.
NPI 1851733539
Hospitalist in Lansdale, PA

NPI Status: Active since July 23, 2013

Contact Information

100 MEDICAL CAMPUS DR
LANSDALE, PA
ZIP 19446
Phone: (215) 361-4854
Fax: (215) 361-4933

NPI Profile Information
Primary Taxonomy
Secondary Taxonomies
Insurance Plans Accepted
Medicare Participation & PECOS Status
Areas of Expertise
Durable Medical Equipment
Physician Visit Costs
Hospital Affiliations - Privileges
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Female
Years of Experience 19
Hospitalist
Accepts Insurance
Accepts Medicare Approved Payment
PECOS Enrolled

About CLAUDIA NIEVES PRADO

This page provides the complete NPI Profile along with additional information for Claudia Nieves Prado, a provider established in Lansdale, Pennsylvania with a medical specialization in Hospitalist and more than 19 years of experience. The healthcare provider is registered in the NPI registry with number 1851733539 assigned on July 2013. The practitioner's primary taxonomy code is 208M00000X with license number MD458704 (PA). The provider is registered as an individual and her NPI record was last updated 4 years ago.

NPI: 1851733539
Provider Name: CLAUDIA ANTONIETA NIEVES PRADO M.D.
Gender: Female
Entity Type: Individual
Location Address: 100 MEDICAL CAMPUS DR LANSDALE, PA 19446
Location Phone: (215) 361-4854
Location Fax: (215) 361-4933
Mailing Address: 100 MEDICAL CAMPUS DR LANSDALE, PA 19446
Mailing Phone: (215) 361-4854
Mailing Fax: (215) 361-4933
Medical School Name: OTHER
Graduation Year: 2007
Is Sole Proprietor?: No
Enumeration Date: 07-23-2013
Last Update Date: 07-21-2022
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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: Hospitalist
Taxonomy Code: 208M00000X
Type: Allopathic & Osteopathic Physicians
License No.: MD458704
License State: PA
Taxonomy Description: Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients.

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	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine	MD458704 (PA)

Insurance Plans Accepted

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

Highmark Blue Cross Blue Shield Delaware

my Blue Access Major Events Select PPO Catastrophic 10600 - 3 Free PCP Visits - PPO
my Blue Access Select PPO Bronze 3800 - PPO
my Blue Access Select PPO Bronze 3800 + Adult Dental and Vision - PPO
my Blue Access Select PPO Bronze 9200 - PPO
my Blue Access Select PPO Gold 0 - PPO
my Blue Access Select PPO Gold 0 + Adult Dental and Vision - PPO
my Blue Access Select PPO Gold 1700 HSA - PPO
my Blue Access Select PPO Premier Gold 0 + Adult Dental and Vision - PPO
my Blue Access Select PPO Premier Platinum 0 + Adult Dental and Vision - PPO
my Blue Access Select PPO Premier Silver 0 + Adult Dental and Vision - PPO
my Blue Access Select PPO Standard Bronze 7500 - PPO
my Blue Access Select PPO Standard Gold 2000 - PPO
my Blue Access Select PPO Standard Gold 2000 + Adult Dental and Vision - PPO
my Blue Access Select PPO Standard Platinum 0 - PPO
my Blue Access Select PPO Standard Silver 6000 - PPO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Medicare Participation & PECOS Enrollment Status

Claudia Nieves Prado 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.

Claudia Nieves Prado 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: 5991083727
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: I20161031000996
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.

Durable Medical Equipment

DME-Oxygen and Supplies (DC000N)
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing (HCPCS:E0431)
1 DME suppliers used 39 Medicare Claims 39 Services Paid
DME-Oxygen and Supplies (DC002N)
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)
2 DME suppliers used 41 Medicare Claims 41 Services Paid

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.

Critical care, first 30-74 minutes
Follow-up hospital inpatient care per day, typically 35 minutes
Follow-up observation care per day, typically 35 minutes
Hospital discharge day management, more than 30 minutes
Hospital observation care on day of discharge
Initial hospital inpatient care per day, typically 70 minutes
Initial hospital observation care per day, typically 70 minutes

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $34.29 for a new patient copayment and $26.3 for an established patient copayment.

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 19446 ZIP code area.

New Patients Visit Costs *

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

Average New Patient Price $137.17
Minimum New Patient Price $59.88
Maximum New Patient Price $180.99

Average New Patient Copayment $34.29
Minimum New Patient Copayment $14.97
Maximum New Patient Copayment $45.24

Established Patients Visit Costs *

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

Average Established Patient Price $105.21
Minimum Established Patient Price $19.3
Maximum Established Patient Price $147.29

Average Established Patient Copayment $26.3
Minimum Established Patient Copayment $4.82
Maximum Established Patient Copayment $36.82

* 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.

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

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. Claudia Nieves Prado is affiliated with the following medical facilities:

Hospital Name	Address	Phone	Hospital Type
BRYN MAWR HOSPITAL	130 SOUTH BRYN MAWR AVE BRYN MAWR, PA 19010	(610) 526-3000	Acute Care Hospitals
MAIN LINE HOSPITAL LANKENAU	100 LANCASTER AVE WYNNEWOOD, PA 19096	(610) 645-2000	Acute Care Hospitals
RIDDLE MEMORIAL HOSPITAL	1068 WEST BALTIMORE PIKE MEDIA, PA 19063	(610) 566-9400	Acute Care Hospitals

NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1851733539, we treat the final digit (9) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 61. The final step is to find the difference between that total and the next multiple of ten (70 - 61 = 9).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 10 → 1 + 0

Pos 4

Unchanged

Pos 5

Doubled → 14 → 1 + 4

Pos 6

Unchanged

Pos 7

Doubled → 6

Pos 8

Unchanged

Pos 9

Doubled → 6

Check

Target digit

Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 5 → 10 → 1 7 → 14 → 5 3 → 6 3 → 6

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 8 + 1 + 0 + 1 + 1 + 4 + 3 + 6 + 5 + 6 + 24 = 61

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 61 is 70. The difference is the calculated check digit.

70 - 61 = 9

This NPI is valid

The calculated check digit is 9, which matches the last digit of 1851733539.