DR. GARY D WIKHOLM MD
NPI 1861598526
Family Medicine in Santa Paula, CA
Active since September 16, 2006PECOS EnrolledAccepts Medicare Assignment
96.5/100
CMS Quality Rating
About Dr. Gary D Wikholm Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. GARY D WIKHOLM MD (NPI 1861598526) is an individual family medicine provider in Santa Paula, California, licensed in California (A41000) and active in the NPI registry since September 2006. He is enrolled in Medicare PECOS and is a graduate of Other (1981).
NPPES Registry Identity
NPI1861598526
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameDR. GARY D WIKHOLMCredential: MD
Location Address247 W HARVARD BLVDSanta Paula, CA 93060-3223
Mailing Address247 W Harvard BlvdSanta Paula, CA 93060-3223 · (805) 525-0907 · Fax (805) 933-3392
Phone(805) 525-0907
Fax(805) 933-3392
Sole ProprietorNo
Medical School CMSOtherGraduated 1981
Enumeration DateSeptember 16, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1861598526 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in CA · A41000
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
247 W HARVARD BLVD, Santa Paula, CA 93060
Other Identifiers 3
Medicare ID-Type UnspecifiedWA41000DCA
Medicaid00A410000CA
Medicare UPINA29268CA
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
✔
Enrolled in Medicare and accepts Medicare assignment
Dr. Gary D Wikholm Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
PECOS PAC ID9234231176
PECOS Enrollment IDI20080108000884
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.
Areas of Expertise CMS Part B claims 4
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes 99309
A follow-up nursing facility visit per day is a daily check-in by a healthcare professional. This 25-minute visit typically involves monitoring your health progress, addressing any concerns, and adjusting treatment plans as necessary. It's a vital part of ensuring your ongoing wellbeing.
449 services81 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
260 services77 patients
Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes 99305
An initial nursing facility visit per day is a service where a healthcare professional spends about 35 minutes assessing a patient's health status. This includes reviewing medical history, conducting a physical exam, and developing a care plan based on the patient's needs.
107 services77 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
32 services32 patients
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 93060 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
New Patient
$95.28 typical visit price
range $62.32 – $185.36
Typical copayment $23.82 (range $15.58 – $46.34)
Most-billed visit code 99203
Established Patient
$108.74 typical visit price
range $20.68 – $151.85
Typical copayment $27.18 (range $5.17 – $37.96)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
96.5/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment ModelQuality
80.34
Promoting Interoperability
100
Improvement Activities
40
Reported Quality Measures
Care Plan
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker…
49%183 patients2/55-star benchmark: 100%
Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy - Neurological Evaluation
Percentage of patients aged 18 years and older with a diagnosis of diabetes mellitus who had a neurological examination of their lower extremities within 12 months
75%93 patients4/55-star benchmark: 100%
Diabetes: Eye Exam
Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period
92%26 patients4/55-star benchmark: 100%
Diabetes: Medical Attention for Nephropathy
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
85%26 patients4/55-star benchmark: 99%
Documentation of Current Medications in the Medical Record
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.
99%3,255 patients4/55-star benchmark: 100%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
84%1,476 patients4/55-star benchmark: 100%
Health Information Exchange
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for…
63%104 patients3/55-star benchmark: 98%
Medication Reconciliation
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
91%207 patients4/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
93%647 patients4/55-star benchmark: 100%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
91%978 patients4/55-star benchmark: 97%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Patients screenedForUse: 100% · 731 patients
Patients tobacco: 2% · 104 patients
91%731 patients4/55-star benchmark: 98%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
63%647 patients3/55-star benchmark: 100%
Secure Messaging
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…
60%647 patients4/55-star benchmark: 79%
Tobacco Use and Help with Quitting Among Adolescents
The percentage of adolescents 12 to 20 years of age with a primary care visit during the measurement year for whom tobacco use status was documented and received help with quitting if identified as a tobacco user
80%55 patients
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.
Referred Medical Equipment & Supplies CMS DME claims 9
Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
5 suppliers41 claims76 services$6.08 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
4 suppliers12 claims13 services$0.96 avg. paid by Medicare
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape B4035
Other-Enteral and Parenteral · category OB006N
2 suppliers13 claims390 services$4.49 avg. paid by Medicare
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit B4150
Other-Enteral and Parenteral · category OB006N
2 suppliers13 claims8,845 services$0.33 avg. paid by Medicare
Iv pole E0776
DME-Other DME · category DE000N
2 suppliers12 claims12 services$9.02 avg. paid by Medicare
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
DME-Oxygen and Supplies · category DC002N
1 supplier12 claims12 services$61.95 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Gary Wikholm's NPI number?
The NPI number for Gary Wikholm is 1861598526. It was assigned to this individual provider in the NPPES registry on September 16, 2006.
Where is Gary Wikholm located?
Gary Wikholm practices at 247 W Harvard Blvd, Santa Paula, CA 93060. The listed phone number is (805) 525-0907.
What is Gary Wikholm's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Gary Wikholm enrolled in Medicare?
Yes. Gary Wikholm is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
When was this NPI record last updated?
The NPPES record for Gary Wikholm was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dr. Gary D Wikholm, MD · NPI 1861598526
Family Medicine physician in Santa Paula, California. Individual provider, active in the CMS NPPES registry since September 16, 2006.
## Identity
- **NPI:** 1861598526 (Entity type: Individual)
- **Enumerated:** September 16, 2006
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **State license:** A41000 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 247 W HARVARD BLVD, Santa Paula, CA 93060-3223
- **Phone:** (805) 525-0907 · **Fax:** (805) 933-3392
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Medical school:** Other, class of 1981
## Record status
- **NPPES last updated:** July 8, 2007
- **Other identifiers:** Medicare ID-Type Unspecified WA41000D (CA); Medicaid 00A410000 (CA); Medicare UPIN A29268 (CA)
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Source: [NPI Profile](https://npiprofile.com/npi/1861598526) · Data from the CMS NPPES public registry.