RAFAEL L IRIZARRY MD NPI 1922020239

Radiology (Diagnostic Radiology) in Jacksonville, FL

NPI 1922020239 Individual Male Years of Experience 27 Radiology Diagnostic Radiology PECOS Enrolled Accepts Medicare Approved Payment MIPS Quality Score 98

NPI Profile for RAFAEL L IRIZARRY MD

Rafael Irizarry is a provider established in Jacksonville, Florida and his medical specialization is radiology (diagnostic radiology) with more than 27 years of experience. He graduated from University Central Del Caribe Escuela De Medicina in 1996. The NPI number of Rafael Irizarry is 1922020239 and was assigned on July 2006. The practitioner's primary taxonomy code is 2085R0202X with license number ME85345 (FL). The provider is registered as an individual and his NPI record was last updated 5 years ago.

Rafael Irizarry 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.

Rafael Irizarry 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 Baptist Health Medical Center - Jacksonville, Orange Park Medical Center, Memorial Hospital Jacksonville, Baptist Medical Center Beaches and Mayo Clinic Health System In Waycross.

The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 98, 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: $22.56 for a new patient copayment and $18.26 for an established patient copayment.

NPI

1922020239

Provider Name RAFAEL L IRIZARRY MD
Provider Location Address3599 UNIVERSITY BLVD S BUILDING 300 JACKSONVILLE, FL 32216
Provider Mailing Address3599 UNIVERSITY BLVD S BUILDING 300 JACKSONVILLE, FL 32216
GenderMale
NPI Entity TypeIndividual
Medical School NameUNIVERSITY CENTRAL DEL CARIBE ESCUELA DE MEDICINA
Graduation Year1996
Is Sole Proprietor?No
Is Organization Subpart?N/A
Enumeration Date07-24-2006
Last Update Date08-21-2017


Primary Taxonomy

Taxonomy Code2085R0202X
ClassificationRadiology
TypeAllopathic & Osteopathic Physicians
SpecializationDiagnostic Radiology
License No.ME85345
License StateFL
Taxonomy DescriptionA radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Business Address

RAFAEL L IRIZARRY MD
3599 UNIVERSITY BLVD S
BUILDING 300
JACKSONVILLE, FL
ZIP 32216
Phone: (904) 399-5550
Fax: (904) 346-4334

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Mailing Address

RAFAEL L IRIZARRY MD
3599 UNIVERSITY BLVD S
BUILDING 300
JACKSONVILLE, FL
ZIP 32216
Phone: (904) 399-5550
Fax: (904) 346-4334



PECOS Enrollment and 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 ID6608931530
PECOS Enrollment IDI20090210000332, I20190201002106
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 32216 ZIP code area.

New Patients Office Visits Costs *
Most Utilized Procedure Code for new patients office visits: 99203
Minimum New Patient Pricing Maximum New Patient Pricing Typical New Patient Pricing
$58.4 $178.79 $90.24
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$14.6 $44.69 $22.56
Established Patients Office Visits Costs *
Most Utilized Procedure Code for established patients office visits: 99213
Minimum Established Patient Pricing Maximum Established Patient Pricing Typical Established Patient Pricing
$17.74 $145.28 $73.05
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$4.43 $36.32 $18.26

* 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% N/A
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% 65.3
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 - 98
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.

  • 550X-ray of chest, 1 view, front (HCPCS:71010)
  • 124X-ray of chest, 2 views, front and side (HCPCS:71020)
  • 34X-ray of abdomen, single view (HCPCS:74000)
  • 26X-ray of shoulder, minimum of 2 views (HCPCS:73030)
  • 22X-ray of ribs of one side of body, minimum of 2 views (HCPCS:73510)
  • 16CT scan of abdomen and pelvis (HCPCS:74176)
  • 15Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers (HCPCS:93971)
  • 14CT scan of abdomen and pelvis with contrast (HCPCS:74177)
  • 11Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers (HCPCS:93970)

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. Rafael Irizarry is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
BAPTIST HEALTH MEDICAL CENTER - JACKSONVILLE800 PRUDENTIAL DR
JACKSONVILLE, FL 32207
(904) 202-2000Acute Care Hospitals100088
ORANGE PARK MEDICAL CENTER2001 KINGSLEY AVE
ORANGE PARK, FL 32073
(904) 276-8500Acute Care Hospitals100226
MEMORIAL HOSPITAL JACKSONVILLE3625 UNIVERSITY BLVD S
JACKSONVILLE, FL 32216
(904) 702-6111Acute Care Hospitals100179
BAPTIST MEDICAL CENTER BEACHES1350 13TH AVE S
JACKSONVILLE BEACH, FL 32250
(904) 247-2900Acute Care Hospitals100117
MAYO CLINIC HEALTH SYSTEM IN WAYCROSS1900 TEBEAU STREET
WAYCROSS, GA 31501
(912) 287-2500Acute Care Hospitals110003

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 Identifier Issuer
H67523MEDICARE UPIN (02)FL
17028MEDICARE ID-TYPE UNSPECIFIED (04)FL
300131415MEDICARE ID-TYPE UNSPECIFIED (04)GARAILROAD
17028OTHER (01)FLBCBS
00955501AMEDICAID (05)GA
264700100MEDICAID (05)FL

NPI Validation Check Digit Calculation


The following table explains step by step the NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1922020239
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
294202026
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 9 + 4 + 2 + 0 + 2 + 0 + 2 + 6 + 24 = 51
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 51 = 99

The NPI number 1922020239 is valid because the calculated check digit 9 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the same location


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

NPI Name / Type Taxonomy Address
1578568952 DAWN NICHELLE ROSADO MPT
Individual
Physical Therapist3599 UNIVERSITY BLVD S
JACKSONVILLE, FL 32216
(904) 854-2090
1578560835DR. GIANCARLO BERTOZZI MD
Individual
Thoracic Surgery (Cardiothoracic Vascular Surgery)3599 UNIVERSITY BLVD S SUITE 802
JACKSONVILLE, FL 32216
(904) 396-2421
1336140938DR. JACK JERRY SALAH M.D.
Individual
Internal Medicine (Pulmonary Disease)3599 UNIVERSITY BLVD S SUITE 901
JACKSONVILLE, FL 32216
(904) 398-6971
1821081183DR. ALEJANDRO A RADI M.D.
Individual
Contractor3599 UNIVERSITY BLVD S SUITE 8
JACKSONVILLE, FL 32216
(904) 398-7001
1205821782DR. NGOCLAN THI DINH M. D.
Individual
Internal Medicine (Gastroenterology)3599 UNIVERSITY BLVD S SUITE 911
JACKSONVILLE, FL 32216
(904) 346-0330
1437138195DR. DENNIS M SMITH MD
Individual
Pathology (Anatomic Pathology & Clinical Pathology)3599 UNIVERSITY BLVD S SUITE 1700
JACKSONVILLE, FL 32216
(904) 858-0110
1528036175DR. GRADY C STEWART MD
Individual
Radiology (Diagnostic Radiology)3599 UNIVERSITY BLVD S BUILDING 300
JACKSONVILLE, FL 32216
(904) 399-5550
1689642266DR. WILLIAM S MORROW MD
Individual
Radiology (Body Imaging)3599 UNIVERSITY BLVD S BUILDING 300
JACKSONVILLE, FL 32216
(904) 399-5550
1962462895 BARBARA L SHARP MD
Individual
Radiology (Diagnostic Radiology)3599 UNIVERSITY BLVD S BUILDING 300
JACKSONVILLE, FL 32216
(904) 399-5550
1275593287 PRASANNA S PRABHU MD
Individual
Radiology (Body Imaging)3599 UNIVERSITY BLVD S BUILDING 300
JACKSONVILLE, FL 32216
(904) 399-5550
1497715312 JAMIE T SURRATT MD
Individual
Radiology (Diagnostic Radiology)3599 UNIVERSITY BLVD S BUILDING 300
JACKSONVILLE, FL 32216
(904) 399-5550
1639139157 LUANN B MOORE MD
Individual
Radiology (Body Imaging)3599 UNIVERSITY BLVD S BLDG 300
JACKSONVILLE, FL 32216
(904) 399-5550
1053371583 JOHN D MCKENZIE MD
Individual
Radiology (Diagnostic Radiology)3599 UNIVERSITY BLVD S BUILDING 300
JACKSONVILLE, FL 32216
(904) 399-5550
1629030044DR. MARK LEONARD ABRAMSON M.D.
Individual
Urology3599 UNIVERSITY BLVD S #804
JACKSONVILLE, FL 32216
(904) 346-3333
1992768410 HOSEIN YASREBI MD
Individual
Surgery3599 UNIVERSITY BLVD S STE 506
JACKSONVILLE, FL 32216
(904) 396-8000
1144287335BAGNOLI AND SALAH PARTNERSHIP
Organization
Internal Medicine (Pulmonary Disease)3599 UNIVERSITY BLVD S SUITE 901
JACKSONVILLE, FL 32216
(904) 398-6971
1962453324DR. LAWRENCE J KANTER MD
Individual
Internal Medicine (Cardiovascular Disease)3599 UNIVERSITY BLVD S SUITE 913
JACKSONVILLE, FL 32216
(904) 399-4120
1124074729MRS. LOUISE ANN AXELBERG
Individual
Social Worker (Clinical)3599 UNIVERSITY BLVD S SUITE 601
JACKSONVILLE, FL 32216
(904) 399-0404
1407803877MRS. CHRISTINA A FEELY A.R.N.P
Individual
Counselor (Mental Health)3599 UNIVERSITY BLVD S SUITE 400
JACKSONVILLE, FL 32216
(904) 399-5966
1639109135 KAREN ELLIOTT A.R.N.P
Individual
Nurse Practitioner3599 UNIVERSITY BLVD S
JACKSONVILLE, FL 32216
(904) 345-7776

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
Rafael L Irizarry Md is registered as an entity type code: 1. The entity type code describes 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.