NELSON W RAITT MD NPI 1881794428

Internal Medicine in Roseville, CA

NPI 1881794428 Individual Male Years of Experience 31 Internal Medicine PECOS Enrolled Accepts Medicare Approved Payment MIPS Quality Score 90.9

About NELSON RAITT

Nelson Raitt is an internal medicine provider established in Roseville, California and his medical specialization is internal medicine with more than 31 years of experience. He graduated from Tulane University School Of Medicine in 1991. The NPI number of Nelson Raitt is 1881794428 and was assigned on September 2006. The practitioner's primary taxonomy code is 207R00000X with license number A52154 (CA). The provider is registered as an individual and his NPI record was last updated 15 years ago.

An internist like Nelson W Raitt Md is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.

Nelson Raitt is enrolled in PECOS and is eligible to order or refer healthcare 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

Nelson Raitt 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 Sutter Roseville Medical Center, Sutter Medical Center, Sacramento and Sutter Auburn Faith Hospital.

The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 90.9, 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 typical physician office visit costs for Medicare beneficiaries in this area are: $35.11 for a new patient copayment and $27.26 for an established patient copayment.

NPI

1881794428

Provider Name NELSON W RAITT MD
Provider Location Address3 MEDICAL PLAZA DR #140 ROSEVILLE, CA 95661
Provider Mailing AddressPO BOX 255228 SACRAMENTO, CA 95865
GenderMale
NPI Entity TypeIndividual
Medical School NameTULANE UNIVERSITY SCHOOL OF MEDICINE
Graduation Year1991
Is Sole Proprietor?No
Is Organization Subpart?N/A
Enumeration Date09-24-2006
Last Update Date07-08-2007


Primary Taxonomy

Taxonomy Code207R00000X
ClassificationInternal Medicine
TypeAllopathic & Osteopathic Physicians
License No.A52154
License StateCA
Taxonomy DescriptionA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Business Address

NELSON W RAITT MD
3 MEDICAL PLAZA DR
#140
ROSEVILLE, CA
ZIP 95661
Phone: (916) 797-4715
Fax: (916) 797-4716

Get Directions


Mailing Address

NELSON W RAITT MD
PO BOX 255228
SACRAMENTO, CA
ZIP 95865
Phone: (800) 470-0071



Medicare Participation

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 ID244302784
PECOS Enrollment IDI20080717000686
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 ImagingYes
Eligible order / refer Durable Medical EquipmentYes
Eligible order / refer Home Health Agency (HHA)Yes
Eligible order / refer Power Mobility DevicesYes

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 95661 ZIP code area.

New Patients Office Visits Costs *
Most Utilized Procedure Code for new patients office visits: 99204
Minimum New Patient Pricing Maximum New Patient Pricing Typical New Patient Pricing
$61.52 $185.29 $140.46
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$15.38 $46.32 $35.11
Established Patients Office Visits Costs *
Most Utilized Procedure Code for established patients office visits: 99214
Minimum Established Patient Pricing Maximum Established Patient Pricing Typical Established Patient Pricing
$19.52 $151.94 $109.06
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$4.88 $37.98 $27.26

* 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% 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.
Promoting Interoperability (PI) 25% 72
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 15% 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 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 20% 69.6
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.
MIPS Final Score - 90.9
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.

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.

  • 156Administration of pneumococcal vaccine (HCPCS:G0009)
  • 150Pneumococcal vaccine for injection into muscle (HCPCS:90670)
  • 99Injection beneath the skin or into muscle for therapy, diagnosis, or prevention (HCPCS:96372)
  • 55Administration of influenza virus vaccine (HCPCS:G0008)
  • 47Routine EKG using at least 12 leads including interpretation and report (HCPCS:93000)
  • 43Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit (HCPCS:G0439)
  • 24Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imple (HCPCS:G0180)

Hospital Affiliations

Medicare hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the Medicare 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. Nelson Raitt is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
SUTTER ROSEVILLE MEDICAL CENTERONE MEDICAL PLAZA
ROSEVILLE, CA 95661
(916) 781-1000Acute Care Hospitals50309
SUTTER MEDICAL CENTER, SACRAMENTO2825 CAPITOL AVENUE
SACRAMENTO, CA 95816
(916) 733-8999Acute Care Hospitals50108
SUTTER AUBURN FAITH HOSPITAL11815 EDUCATION STREET
AUBURN, CA 95603
(530) 888-4500Acute Care Hospitals50498

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
F86868MEDICARE UPIN (02)
00A521540MEDICARE ID-TYPE UNSPECIFIED (04)
00A521540MEDICAID (05)CA

Other Providers at the same location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1013028760 SUZANNE M DEGAN PTA
Individual
Physical Therapy Assistant3 MEDICAL PLAZA DR #100
ROSEVILLE, CA 95661
(916) 781-1392
1386755965 RANDOLPH F EUGENIO PT
Individual
Physical Therapist3 MEDICAL PLAZA DR #100
ROSEVILLE, CA 95661
(916) 781-5188
1194836601 KIMBERLY S FLYNN PTA
Individual
Physical Therapy Assistant3 MEDICAL PLAZA DR #100
ROSEVILLE, CA 95661
(916) 781-5191
1679678700 JULIANNA L MONROE PT
Individual
Physical Therapist3 MEDICAL PLAZA DR #100
ROSEVILLE, CA 95661
(916) 781-5188
1104921667 LOU D LEVY PTA
Individual
Physical Therapy Assistant3 MEDICAL PLAZA DR #100
ROSEVILLE, CA 95661
(916) 781-1421
1770689374 KATHLEEN B O'BRIEN OT
Individual
Occupational Therapist3 MEDICAL PLAZA DR #100
ROSEVILLE, CA 95661
(916) 781-5188
1780781708 LEEANN SNYDER-MARTIN PTA
Individual
Physical Therapy Assistant3 MEDICAL PLAZA DR #100
ROSEVILLE, CA 95661
(916) 781-5188
1902906738 KATHERINE E. PETERSON PT
Individual
Physical Therapist3 MEDICAL PLAZA DR SUITE 100
ROSEVILLE, CA 95661
(916) 781-5195
1225185622 APRIL A. CAUTHEN NP
Individual
Nurse Practitioner3 MEDICAL PLAZA DR SUITE 140
ROSEVILLE, CA 95661
(916) 797-4715
1033240007MS. LINDA LORRAINE MEYERS LCSW
Individual
Social Worker (Clinical)3 MEDICAL PLAZA DR SUITE 200
ROSEVILLE, CA 95661
(530) 478-1273
1902068232 HEATHER D VAN HORN PTA
Individual
Physical Therapy Assistant3 MEDICAL PLAZA DR SUITE 100
ROSEVILLE, CA 95661
(916) 773-7910
1649570649 KAREN E DEMARCO OTA
Individual
Occupational Therapy Assistant3 MEDICAL PLAZA DR SUITE 100
ROSEVILLE, CA 95661
(916) 781-5188
1205093176 DMITRI V GELFAND MD
Individual
Surgery (Vascular Surgery)3 MEDICAL PLAZA DR #130
ROSEVILLE, CA 95661
(916) 773-8750
1366557266 BEVERLY F BRUCE OT
Individual
Occupational Therapist3 MEDICAL PLAZA DR SUITE 100
ROSEVILLE, CA 95661
(916) 781-5188
1053410571 TRACEY J JOHNSON NP
Individual
Nurse Practitioner3 MEDICAL PLAZA DR #260
ROSEVILLE, CA 95661
(916) 773-7977
1306957584 STEPHEN M HANKINS MD
Individual
Orthopaedic Surgery (Hand Surgery)3 MEDICAL PLAZA DR #110
ROSEVILLE, CA 95661
(916) 797-4725
1801210539 IGOR SHKURATOV
Individual
Occupational Therapist3 MEDICAL PLAZA DR SUITE 100
ROSEVILLE, CA 95661
(916) 797-4734
1821094475DR. DOUGLAS HIGHT DPM
Individual
Podiatrist (Primary Podiatric Medicine)3 MEDICAL PLAZA DR SUITE 110
ROSEVILLE, CA 95661
(916) 733-7905
1629173729 JAMES L MAHER MD
Individual
Obstetrics & Gynecology3 MEDICAL PLAZA DR #260
ROSEVILLE, CA 95661
(916) 773-7977
1609954312 DOUGLAS W. FREEMAN MD
Individual
Otolaryngology3 MEDICAL PLAZA DR SUITE 220
ROSEVILLE, CA 95661
(916) 773-7923

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
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.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.