DARLENE BLANCHARD MD
NPI 1912087347
Surgery in Fredericksburg, VA

NPI Status: Active since October 17, 2006

Contact Information

4548 EMPIRE CT
FREDERICKSBURG, VA
ZIP 22408
Phone: (540) 373-2244
Fax: (540) 371-4849

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Medicare Participation & PECOS Status
Areas of Expertise
Durable Medical Equipment
Physician Visit Costs
Quality Reporting
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Female
Surgery
PECOS Enrolled
Medicare Quality Reporting

About DARLENE BLANCHARD

This page provides the complete NPI Profile along with additional information for Darlene Blanchard, a provider established in Fredericksburg, Virginia with a medical specialization in Surgery. The healthcare provider is registered in the NPI registry with number 1912087347 assigned on October 2006. The practitioner's primary taxonomy code is 208600000X with license number 0101242194 (VA). The provider is registered as an individual and her NPI record was last updated 15 years ago.

NPI: 1912087347
Provider Name: DARLENE BLANCHARD MD
Gender: Female
Entity Type: Individual
Location Address: 4548 EMPIRE CT FREDERICKSBURG, VA 22408
Location Phone: (540) 373-2244
Location Fax: (540) 371-4849
Mailing Address: 4548 EMPIRE CT FREDERICKSBURG, VA 22408
Mailing Phone: (540) 373-2244
Mailing Fax: (540) 371-4849
Is Sole Proprietor?: No
Enumeration Date: 10-17-2006
Last Update Date: 01-05-2011
Code Navigator

A surgeon like Darlene Blanchard treats injuries, diseases, and deformities through surgical operations. A surgeon could correct physical deformities, repair bone and tissue, or perform preventive or elective surgeries. Surgeons also examine patients, perform and interpret diagnostic tests, and provide counsel on preventive healthcare.

Location Map

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: Surgery
Taxonomy Code: 208600000X
Type: Allopathic & Osteopathic Physicians
License No.: 0101242194
License State: VA
Taxonomy Description: A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Insurance Plans Accepted

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

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

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

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State	Identifier Issuer
H00267	MEDICARE UPIN (02)

Medicare Participation & PECOS Enrollment Status

Darlene Blanchard 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
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.

Orthotic Devices

DME-Orthotic Devices (DF000N)
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type (HCPCS:L8000)
3 DME suppliers used 52 Medicare Claims 200 Services Paid
DME-Orthotic Devices (DF000N)
Breast prosthesis, mastectomy form (HCPCS:L8020)
1 DME suppliers used 29 Medicare Claims 31 Services Paid
DME-Orthotic Devices (DF000N)
Breast prosthesis, silicone or equal, without integral adhesive (HCPCS:L8030)
2 DME suppliers used 32 Medicare Claims 36 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.

Biopsy or removal of deep lymph nodes of underarm
Established patient office or other outpatient visit, 20-29 minutes
Established patient office or other outpatient visit, 30-39 minutes
Established patient office or other outpatient visit, 40-54 minutes
Fluoroscopic guidance for insertion or removal of central vein access device
Imaging of lymph nodes during surgery
Insertion of central venous tube with port (5 years or older)
Mastectomy
Melanoma (skin cancer) excision
New patient office or other outpatient visit, 30-44 minutes
New patient office or other outpatient visit, 45-59 minutes
New patient office or other outpatient visit, 60-74 minutes
Partial removal of breast
Removal of growth of breast identified by x-ray marker, first growth
Simple complete removal of breast
X-ray of surgical specimen

Physician Visit Costs

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 22408 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

Average New Patient Price $86.88
Minimum New Patient Price $56.19
Maximum New Patient Price $170.3

Average New Patient Copayment $21.72
Minimum New Patient Copayment $14.04
Maximum New Patient Copayment $42.57

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

Average Established Patient Price $70.08
Minimum Established Patient Price $18.07
Maximum Established Patient Price $138.91

Average Established Patient Copayment $17.52
Minimum Established Patient Copayment $4.51
Maximum Established Patient Copayment $34.72

* 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.

Quality Reporting

The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

Quality Measure	Performance	Number of Patients
Annual registration in the Prescription Drug Monitoring Program	Yes	N/A
Annual registration by eligible clinician or group in the prescription drug monitoring program of the state where they practice. Activities that simply involve registration are not sufficient. MIPS eligible clinicians and groups must participate for a minimum of 6 months.
Breast Cancer Screening	4%	1229
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
Care transition documentation practice improvements	Yes	N/A
Implementation of practices/processes for care transition that include documentation of how a MIPS eligible clinician or group carried out a patient-centered action plan for first 30 days following a discharge (e.g., staff involved, phone calls conducted in support of transition, accompaniments, navigation actions, home visits, patient information access, etc.).
Consultation of the Prescription Drug Monitoring Program	Yes	N/A
Clinicians would attest to reviewing the patients’ history of controlled substance prescription using state prescription drug monitoring program (PDMP) data prior to the issuance of a Controlled Substance Schedule II (CSII) opioid prescription lasting longer than 3 days. For the transition year, clinicians would attest to 60 percent review of applicable patient’s history. For the Quality Payment Program Year 2 and future years, clinicians would attest to 75 percent review of applicable patient’s history performance.
Engagement of New Medicaid Patients and Follow-up	Yes	N/A
Seeing new and follow-up Medicaid patients in a timely manner, including individuals dually eligible for Medicaid and Medicare. A timely manner is defined as within 10 business days for this activity.
Engagement of Patients, Family, and Caregivers in Developing a Plan of Care	Yes	N/A
Engage patients, family, and caregivers in developing a plan of care and prioritizing their goals for action, documented in the electronic health record (EHR) technology.
Implementation of Use of Specialist Reports Back to Referring Clinician or Group to Close Referral Loop	Yes	N/A
Performance of regular practices that include providing specialist reports back to the referring individual MIPS eligible clinician or group to close the referral loop or where the referring individual MIPS eligible clinician or group initiates regular inquiries to specialist for specialist reports which could be documented or noted in the EHR technology.
Improved Practices that Disseminate Appropriate Self-Management Materials	Yes	N/A
Provide self-management materials at an appropriate literacy level and in an appropriate language.
Pneumococcal Vaccination Status for Older Adults	0%	973
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
Provide Education Opportunities for New Clinicians	Yes	N/A
MIPS eligible clinicians acting as a preceptor for clinicians-in-training (such as medical residents/fellows, medical students, physician assistants, nurse practitioners, or clinical nurse specialists) and accepting such clinicians for clinical rotations in community practices in small, underserved, or rural areas.
Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms.	Yes	N/A
Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms.
Tobacco use	Yes	N/A
Tobacco use: Regular engagement of MIPS eligible clinicians or groups in integrated prevention and treatment interventions, including tobacco use screening and cessation interventions (refer to NQF #0028) for patients with co-occurring conditions of behavioral or mental health and at risk factors for tobacco dependence.

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 1912087347, we treat the final digit (7) 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 63. The final step is to find the difference between that total and the next multiple of ten (70 - 63 = 7).

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 → 2

Pos 4

Unchanged

Pos 5

Doubled → 0

Pos 6

Unchanged

Pos 7

Doubled → 14 → 1 + 4

Pos 8

Unchanged

Pos 9

Doubled → 8

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 1 → 2 0 → 0 7 → 14 → 5 4 → 8

Step 2: Add all digits plus the NPI constant

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

2 + 9 + 2 + 2 + 0 + 8 + 1 + 4 + 3 + 8 + 24 = 63

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

The next multiple of ten after 63 is 70. The difference is the calculated check digit.

70 - 63 = 7

This NPI is valid

The calculated check digit is 7, which matches the last digit of 1912087347.