WALTER JOHN MARBACH MD
NPI 1891703591
Internal Medicine - Rheumatology in Crestwood, IL

Medicare Participation & PECOS Enrollment Status

Walter Marbach 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.

Walter Marbach 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: 4880784917

  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: I20071213000260

  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

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.

Administration of chemotherapy into vein, 1 hour or less

Chemotherapy is a treatment that uses drugs to destroy cancer cells. When administered into a vein, it's often through an IV. This procedure usually lasts 1 hour or less. You may feel a slight pinch as the needle is inserted, but it's generally painless.

This service was performed 139 times for 54 patients

Administration of chemotherapy into vein, each additional hour

Chemotherapy is a treatment method that uses drugs to destroy cancer cells. The drugs are administered into a vein, usually in the arm. Each additional hour of chemotherapy allows for more of the medication to enter your bloodstream to fight against the cancer cells.

This service was performed 141 times for 52 patients

Established patient office or other outpatient visit, 10-19 minutes

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

This service was performed 22 times for 18 patients

Established patient office or other outpatient visit, 20-29 minutes

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

This service was performed 159 times for 85 patients

Established patient office or other outpatient visit, 30-39 minutes

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.

This service was performed 41 times for 28 patients

Infusion into a vein for hydration, each additional hour

This procedure involves delivering fluids directly into your vein to keep your body hydrated. It is typically done when oral hydration is insufficient. Each additional hour means more fluid is infused to ensure adequate hydration.

This service was performed 27 times for 11 patients

Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less

This is a procedure where a medical professional inserts a small tube into your vein to deliver medication, nutrients, or fluids directly into your bloodstream. This can be for treatment, prevention, or diagnosis. The process typically takes less than an hour.

This service was performed 919 times for 238 patients

Infusion into a vein for therapy, prevention, or diagnosis, each additional hour

This procedure involves delivering medication, fluids, or nutrients directly into your vein. This is done to treat, prevent, or diagnose various conditions. Each additional hour refers to the extended time you may need to receive these substances for optimal results.

This service was performed 192 times for 36 patients

Injection of additional new drug or substance into vein

This procedure involves introducing a new medication or substance into your bloodstream via a vein. It's typically done using a small needle. The substance can help treat various conditions or assist in diagnostic procedures. It's generally safe and monitored by professionals.

This service was performed 108 times for 27 patients

Injection of drug or substance under skin or into muscle

This procedure involves administering medication directly under the skin or into a muscle. A small needle is used to inject the drug, allowing it to be absorbed quickly into the bloodstream. It's a common method for delivering a variety of medications.

This service was performed 281 times for 89 patients

Injection, belatacept, 1 mg

Belatacept is a medication administered through an injection to help manage your immune system after a kidney transplant. This medicine aids in preventing the body from rejecting the new kidney by reducing immune system activity.

This service was performed 54,975 times for 22 patients

Injection, benralizumab, 1 mg

Benralizumab is a medication given via injection to help manage severe asthma. It works by reducing the number of eosinophils, a type of white blood cell that can contribute to asthma symptoms.

This service was performed 1,500 times for 16 patients

Injection, ceftriaxone sodium, per 250 mg

Ceftriaxone sodium is an antibiotic injection used to treat a variety of bacterial infections. Each injection contains 250 mg of the medicine. It works by stopping the growth of bacteria in your body.

This service was performed 425 times for 11 patients

Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)

Certolizumab pegol is a medication injected under a doctor's supervision. It's used to treat certain inflammatory conditions like rheumatoid arthritis. The injection helps reduce symptoms like pain and swelling. Note that this drug isn't for self-administration.

This service was performed 22,000 times for 12 patients

Injection, dalbavancin, 5 mg

Dalbavancin injection is an antibiotic used to treat severe skin infections caused by certain bacteria. The 5mg dosage is administered by healthcare professionals into a vein, usually once a week. It works by stopping the growth of bacteria.

This service was performed 15,675 times for 45 patients

Injection, daptomycin, 1 mg

Daptomycin is an antibiotic injection used to treat severe bacterial infections. It works by stopping bacteria from growing and multiplying. The 1 mg dosage refers to the amount of daptomycin in each injection. It's administered by healthcare professionals.

This service was performed 71,525 times for 16 patients

Injection, denosumab, 1 mg

Denosumab is a medication given via injection to strengthen your bones. It works by slowing down the cells that break down bone, improving bone density and reducing the risk of fractures. It's often used for osteoporosis treatment.

This service was performed 1,200 times for 15 patients

Injection, diphenhydramine hcl, up to 50 mg

Diphenhydramine HCL injection is a medicine given to alleviate symptoms of allergies, colds, or hay fever. It can also help with motion sickness and certain symptoms of Parkinson's disease. Up to 50 mg may be administered depending on your condition.

This service was performed 37 times for 16 patients

Injection, ertapenem sodium, 500 mg

Ertapenem sodium is a potent antibiotic administered via injection to treat a variety of serious bacterial infections. The 500 mg dosage helps your body fight off these bacteria effectively. It's given by a healthcare professional, often in a hospital setting.

This service was performed 394 times for 37 patients

Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg

The Gammagard Liquid injection is a type of immune globulin therapy. It's used to boost your body's immune system, helping it fight off infections. The therapy involves injecting a liquid form of proteins, collected from healthy donors, into your body. This is a 500mg dose.

This service was performed 6,751 times for 24 patients

Injection, infliximab, excludes biosimilar, 10 mg

Infliximab is a medication given via injection to treat certain autoimmune conditions. It works by blocking the action of a substance in your body that causes inflammation. Each dose is based on your medical condition and response to treatment.

This service was performed 8,332 times for 44 patients

Injection, omalizumab, 5 mg

Omalizumab is a medication given via injection. It's used to treat severe allergic asthma and chronic hives when other treatments fail. The 5mg dose is determined by your doctor based on your weight and condition.

This service was performed 6,795 times for 19 patients

Injection, vedolizumab, 1 mg

Vedolizumab is a medication given via injection. It's used to treat certain bowel conditions (such as Crohn's disease, ulcerative colitis) by reducing inflammation. It works by blocking a certain protein that causes this inflammation.

This service was performed 18,300 times for 26 patients

Insertion of needle into vein for collection of blood sample

This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.

This service was performed 170 times for 78 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $34.71 for a new patient copayment and $26.42 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 60445 ZIP code area.

* 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. Walter Marbach is affiliated with the following medical facilities:

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