TODD J GAVIN MD
NPI 1922087964
Ophthalmology in Mankato, MN
NPI Status: Active since January 10, 2006
Contact Information
23886 STATE HIGHWAY 22
MANKATO, MN
ZIP 56001
Phone: (507) 625-1424
- Individual
- Male
- Ophthalmology
- Accepts Insurance
- PECOS Enrolled
- Medicare Quality Reporting
About TODD GAVIN
This page provides the complete NPI Profile along with additional information for Todd Gavin, a provider established in Mankato, Minnesota with a medical specialization in Ophthalmology. The healthcare provider is registered in the NPI registry with number 1922087964 assigned on January 2006. The practitioner's primary taxonomy code is 207W00000X with license number 35388 (MN). The provider is registered as an individual and his NPI record was last updated 4 years ago.
- NPI
- 1922087964
- Provider Name
- TODD J GAVIN MD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 23886 STATE HIGHWAY 22 MANKATO, MN 56001
- Location Phone
- (507) 625-1424
- Mailing Address
- 23886 STATE HIGHWAY 22 MANKATO, MN 56001
- Mailing Phone
- (507) 625-1424
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 01-10-2006
- Last Update Date
- 10-27-2022
- Code Navigator
Ophthalmologists like Todd Gavin specialize in diagnosing and treating eye conditions. They may perform surgeries to correct vision issues or prevent vision loss due to diseases like glaucoma. Additionally, they can provide eyeglasses, prescribe contact lenses, and offer other vision-related services.
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
Ophthalmology
- Taxonomy Code
- 207W00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 35388
- License State
- MN
- Taxonomy Description
- An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Engage by Medica Bronze HSA - EPO
- Engage by Medica Bronze Share - EPO
- Engage by Medica Expanded Bronze Standard - EPO
- Engage by Medica Gold $0 Copay PCP Visits - EPO
- Engage by Medica Gold Share - EPO
- Engage by Medica Gold Standard - EPO
- Engage by Medica Silver $0 Copay PCP Visits - EPO
- Engage by Medica Silver Share - EPO
- Engage by Medica Silver Standard - EPO
- Medica Individual Choice Bronze $0 Copay PCP Visits - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
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 |
|---|---|---|---|
| NA2951011001 | OTHER (01) | MN | PREFERRED ONE |
| 41084933956001C043 | OTHER (01) | CHAMPUS | |
| 970917 | OTHER (01) | MN | AMERICAS PPO |
| 115539 | OTHER (01) | MN | UCARE |
| 1M469GA | OTHER (01) | MN | BCBS |
| HP25582 | OTHER (01) | MN | HEALTH PARTNERS |
| 0802344 | OTHER (01) | MN | MEDICA |
| 180021519 | OTHER (01) | RR MEDICARE | |
| 676207700 | MEDICAID (05) | MN | |
| 937847 | MEDICAID (05) | IA |
Medicare Participation & PECOS Enrollment Status
Todd Gavin 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
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.
Established patient complete exam of visual system
Established patient problem focused exam of visual system
New patient complete exam of visual system
Removal of cataract with insertion of prosthetic lens
Removal of recurring cataract in lens capsule using a laser
Ultrasound scan to determine eye length and lens power
An established patient complete exam of the visual system involves a thorough check of your eyes and vision. It assesses eye health, checks for diseases, and measures your ability to see clearly at different distances. It's a routine, non-invasive procedure.
This service was performed 44 times for 40 patientsThis is a routine check-up for existing patients focusing on the visual system. It involves examining your eyes to detect any potential issues or changes in your vision. It's a crucial part of maintaining good eye health.
This service was performed 17 times for 14 patientsA new patient complete exam of the visual system is a thorough evaluation of your eyes and vision. It checks for any potential issues and assesses overall eye health. It includes tests for visual acuity, eye movement, and light response.
This service was performed 63 times for 63 patientsThis is a procedure where a cloudy lens in your eye, known as a cataract, is removed. After removal, a clear artificial lens is inserted. This helps to restore your vision, enabling you to see clearly again.
This service was performed 74 times for 43 patientsThis procedure, known as YAG laser capsulotomy, treats cloudiness in the lens capsule following cataract surgery. A laser is used to create a small hole in the cloudy capsule, allowing light to pass through and restore clear vision. It's a quick, painless procedure.
This service was performed 25 times for 25 patientsAn ultrasound scan for the eye is a safe, non-invasive procedure. It uses sound waves to create images of your eye's structure. This helps determine the length of your eye and the power of your lens, which is crucial for diagnosing eye conditions and planning surgeries.
This service was performed 34 times for 27 patientsPhysician 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 56001 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $127.61
- Minimum New Patient Price $56
- Maximum New Patient Price $168.28
- Average New Patient Copayment $31.9
- Minimum New Patient Copayment $14
- Maximum New Patient Copayment $42.07
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $69.74
- Minimum Established Patient Price $18.32
- Maximum Established Patient Price $138.04
- Average Established Patient Copayment $17.43
- Minimum Established Patient Copayment $4.58
- Maximum Established Patient Copayment $34.51
* 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 |
|---|---|---|
| Collection and use of patient experience and satisfaction data on access | Yes | N/A |
| Collection of patient experience and satisfaction data on access to care and development of an improvement plan, such as outlining steps for improving communications with patients to help understanding of urgent access needs. | ||
| Diabetes: Eye Exam | 92% | 25 |
| 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 | ||
| Documentation of Current Medications in the Medical Record | 64% | 474 |
| 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. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration | ||
| 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. | ||
| Implementation of documentation improvements for practice/process improvements | Yes | N/A |
| Implementation of practices/processes that document care coordination activities (e.g., a documented care coordination encounter that tracks all clinical staff involved and communications from date patient is scheduled for outpatient procedure through day of procedure). | ||
| Leadership engagement in regular guidance and demonstrated commitment for implementing practice improvement changes | Yes | N/A |
| Ensure full engagement of clinical and administrative leadership in practice improvement that could include one or more of the following: Make responsibility for guidance of practice change a component of clinical and administrative leadership roles; Allocate time for clinical and administrative leadership for practice improvement efforts, including participation in regular team meetings; and/or Incorporate population health, quality and patient experience metrics in regular reviews of practice performance. | ||
| Medication Reconciliation | 98% | 360 |
| 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. | ||
| Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation | 63% | 27 |
| Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits within 12 months | ||
| Provide Patient Access | 96% | 360 |
| 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 certain information. | ||
| Secure Messaging | 0% | 360 |
| 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 message sent by the patient (or the patient-authorized representative) during the performance period. | ||
| Security Risk Analysis | Yes | N/A |
| Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process. | ||
| 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. | ||
| Use of High-Risk Medications in the Elderly | 0% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better. | 217 |
| Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication. 2) Percentage of patients who were ordered at least two of the same high-risk medication | ||
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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 1922087964, we treat the final digit (4) 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 66. The final step is to find the difference between that total and the next multiple of ten (70 - 66 = 4).
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.
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.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 66 is 70. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1922087964, enumerated as an "individual" on January 10, 2006.
The provider is located at 23886 STATE HIGHWAY 22 MANKATO, MN 56001 and the phone number is (507) 625-1424.
Ophthalmology with taxonomy code 207W00000X.
The provider might be accepting Accepts: Medica, Medicare, Medicaid, Tricare, Blue Cross. Please consult your insurance carrier or call the provider to verify.
