ERIN MARY MCMAHON CRNP
NPI 1922648724
Nurse Practitioner - Women's Health in Saint Marys, PA


Quality Rating: 100 out of 100 score

NPI Status: Active since January 09, 2020

Contact Information

761 JOHNSONBURG RD
SAINT MARYS, PA
ZIP 15857
Phone: (814) 788-8118
Fax: (814) 788-8022

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  • Individual
  • Female
  • Years of Experience 6
  • Nurse Practitioner
  • Women's Health
  • PECOS Enrolled
  • Accepts Medicare Approved Payment

About ERIN MCMAHON

Erin Mcmahon is a provider established in Saint Marys, Pennsylvania and her medical specialization is Nurse Practitioner with a focus in women's health with more than 6 years of experience. The healthcare provider is registered in the NPI registry with number 1922648724 assigned on January 2020. The practitioner's primary taxonomy code is 363LW0102X with license number SP021287 (PA). The provider is registered as an individual and her NPI record was last updated 5 years ago.

NPI
1922648724
Provider Name
ERIN MARY MCMAHON CRNP
Gender
Female
Entity Type
Individual
Location Address
761 JOHNSONBURG RD SAINT MARYS, PA 15857
Location Phone
(814) 788-8118
Location Fax
(814) 788-8022
Mailing Address
761 JOHNSONBURG RD SAINT MARYS, PA 15857
Mailing Phone
(814) 788-8118
Mailing Fax
(814) 788-8022
Medical School Name
OTHER
Graduation Year
2019
Is Sole Proprietor?
No
Enumeration Date
01-09-2020
Last Update Date
01-09-2020
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A nurse practitioner (NP) like Erin Mcmahon is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.

Erin Mcmahon 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.

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 100, 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: $21.99 for a new patient copayment and $25.4 for an established patient copayment.

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

Nurse Practitioner Women's Health

Taxonomy Code
363LW0102X
Type
Physician Assistants & Advanced Practice Nursing Providers
License No.
SP021287
License State
PA

Insurance Plans Accepted

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

  • Ambetter from Buckeye Health Plan

    • Choice Bronze HSA - HMO
    • Choice Bronze HSA + Vision + Adult Dental - HMO
    • Clear Gold - HMO
    • Clear Gold + Vision + Adult Dental - HMO
    • Clear Silver - HMO
    • Clear Silver + Vision + Adult Dental - HMO
    • Complete Gold - HMO
    • Complete Gold + Vision + Adult Dental - HMO
    • Complete Silver - HMO
    • Complete Silver + Vision + Adult Dental - HMO
    • Elite Bronze - HMO
    • Elite Bronze + Vision + Adult Dental - HMO
    • Everyday Bronze - HMO
    • Everyday Bronze + Vision + Adult Dental - HMO
    • Everyday Gold - HMO
    • Everyday Gold + Vision + Adult Dental - HMO
    • Focused Silver - HMO
    • Focused Silver + Vision + Adult Dental - HMO
    • Standard Expanded Bronze - HMO
    • Standard Expanded Bronze + Vision + Adult Dental - HMO
  • Ambetter Health of Delaware

    • Clear Gold - EPO
    • Clear Gold + Vision + Adult Dental - EPO
    • Clear Silver - EPO
    • Clear Silver + Vision + Adult Dental - EPO
    • Complete Gold - EPO
    • Complete Gold + Vision + Adult Dental - EPO
    • Elite Bronze - EPO
    • Elite Bronze + Vision + Adult Dental - EPO
    • Everyday Bronze - EPO
    • Everyday Bronze + Vision + Adult Dental - EPO
    • Everyday Gold - EPO
    • Everyday Gold + Vision + Adult Dental - EPO
    • Everyday Silver - EPO
    • Everyday Silver + Vision + Adult Dental - EPO
    • Focused Silver - EPO
    • Focused Silver + Vision + Adult Dental - EPO
    • Premier Bronze HSA - EPO
    • Premier Bronze HSA + Vision + Adult Dental - EPO
    • Standard Expanded Bronze - EPO
    • Standard Expanded Bronze + Vision + Adult Dental - EPO

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

PECOS Enrollment and Medicare Participation Status

Erin Mcmahon 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: 7214364710

    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: I20200224000014

    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

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 15857 ZIP code area.

New Patients Visit Costs *

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

  • Average New Patient Price $87.96
  • Minimum New Patient Price $57.02
  • Maximum New Patient Price $174.05
  • Average New Patient Copayment $21.99
  • Minimum New Patient Copayment $14.25
  • Maximum New Patient Copayment $43.51

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

  • Average Established Patient Price $101.62
  • Minimum Established Patient Price $17.59
  • Maximum Established Patient Price $142.08
  • Average Established Patient Copayment $25.4
  • Minimum Established Patient Copayment $4.39
  • Maximum Established Patient Copayment $35.52

* 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.

Overall MIPS Quality Performance

The Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS 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.

  • Final Score: 100 out of 100

    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.

  • Quality Score: 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 Score: 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 Score: 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 activities measure category compromises 15% providers final MPIS scores.

    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 Score: N/A

    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.

  • Cost Score: N/A

    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.

Clinician Services

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 2020. The reported codes are based on the top 5 codes for each available specialty, excluding evaluation and management codes.

  • 13

    Cervical or vaginal cancer screening; pelvic and clinical breast examination (HCPCS:G0101)

  • 11

    Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory (HCPCS:Q0091)

Hospital Affiliations

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. Erin Mcmahon is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
UPMC KANE4372 ROUTE 6
KANE, PA 16735
(814) 837-8585Acute Care Hospitals
PENN HIGHLANDS ELK763 JOHNSONBURG ROAD
SAINT MARYS, PA 15857
(814) 788-8000Critical Access Hospitals

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NPI Validation Check Digit Calculation


The following table explains the step by step 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.
1922648724
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
29421241674
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 9 + 4 + 2 + 1 + 2 + 4 + 1 + 6 + 7 + 4 + 24 = 66
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 66 = 44

The NPI number 1922648724 is valid because the calculated check digit 4 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
1740274729 JOHN MICHAEL GORLOWSKI M.D.
Individual
Pediatrics (Adolescent Medicine)761 JOHNSONBURG RD SUITE 360
ST MARYS, PA 15857
(814) 781-8677
1205823424ELK REGIONAL PROFESSIONAL GROUP, INC.
Organization
Surgery761 JOHNSONBURG RD ERPG SPECIALTY SERVICES
SAINT MARYS, PA 15857
(814) 788-8615
1205885944DR. DONALD HENRY RUDICK MD
Individual
Specialist761 JOHNSONBURG RD SUITE 350
ST MARYS, PA 15857
(814) 781-8669
1699722231JOSEPH & SUBRAMANY, INC.
Organization
Specialist761 JOHNSONBURG RD SUITE 130
ST MARYS, PA 15857
(814) 781-1188
1578628806 LEI CHEN MD
Individual
Obstetrics & Gynecology (Obstetrics)761 JOHNSONBURG RD
ST MARYS, PA 15857
(814) 834-6139
1053509513TRI-COUNTY UROLOGY INC
Organization
Urology761 JOHNSONBURG RD SUITE 350
SAINT MARYS, PA 15857
(814) 781-8669
1043477946JOHN M GORLOWSKI MD PC
Organization
Pediatrics (Adolescent Medicine)761 JOHNSONBURG RD SUITE 360
SAINT MARYS, PA 15857
(814) 781-8677
1447231378DR. TED BRUBAKER ESHBACH M.D.
Individual
Orthopaedic Surgery761 JOHNSONBURG RD SUITE 310
ST MARYS, PA 15857
(814) 834-1686
1609889583 DAVID HOWARD JOHE MD
Individual
Orthopaedic Surgery761 JOHNSONBURG RD
SAINT MARYS, PA 15857
(814) 781-8655
1336120146MS. MEGEN HANDLEY CRNP
Individual
Nurse Practitioner761 JOHNSONBURG RD SUITE 310
ST MARYS, PA 15857
(814) 834-1686
1407858277 ANNE M BREINDEL PA-C
Individual
Physician Assistant (Medical)761 JOHNSONBURG RD SUITE 240
SAINT MARYS, PA 15857
(814) 834-6565
1861401424DR. STEVEN KOCH MD
Individual
Obstetrics & Gynecology761 JOHNSONBURG RD SUITE 210
SAINT MARYS, PA 15857
(814) 788-8118
1124403035DUBOIS REGIONAL MEDICAL CENTER - PENN HIGHLANDS FAMILY MEDICINE
Organization
Family Medicine761 JOHNSONBURG RD SUITE 240
SAINT MARYS, PA 15857
(814) 788-8183
1043687213DUBOIS REGIONAL MED CENTER - PENN HIGHLANDS FAMILY MED ST MARYS 94150
Organization
Family Medicine761 JOHNSONBURG RD SUITE 220
SAINT MARYS, PA 15857
(814) 834-2850
1831574375DUBOIS REGIONAL MEDICAL CENTER - PENN HIGHLANDS MEDICAL ARTS BLDG ELK
Organization
Family Medicine761 JOHNSONBURG RD
SAINT MARYS, PA 15857
(814) 371-2200
1205849197MRS. ANDREA LEE INZANA PA-C
Individual
Physician Assistant761 JOHNSONBURG RD SUITE 310
SAINT MARYS, PA 15857
(814) 834-1686
1700239068 SARAH MEANS PA-C
Individual
Physician Assistant761 JOHNSONBURG RD SUITE 210
SAINT MARYS, PA 15857
(814) 788-8118
1881870905DR. ANUJIT SINGH DO
Individual
Internal Medicine761 JOHNSONBURG RD SUITE 220
SAINT MARYS, PA 15857
(814) 788-8184
1437693868MRS. NICOLE LYNN VILLELLA CRNP
Individual
Nurse Practitioner761 JOHNSONBURG RD
SAINT MARYS, PA 15857
(814) 788-8777
1821085044ELK REGIONAL PROFESSIONAL GROUP, INC
Organization
Physical Therapist761 JOHNSONBURG RD SUITE 310
ST MARYS, PA 15857
(814) 788-8188

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1922648724, enumerated in the NPI registry as an "individual" on January 09, 2020

The provider is located at 761 Johnsonburg Rd Saint Marys, Pa 15857 and the phone number is (814) 788-8118

The provider's speciality is Nurse Practitioner with taxonomy code 363LW0102X with a focus in Women's Health

The provider has more than 6 years of experience.

The provider might be accepting Accepts: Ambetter from Buckeye Health Plan and Ambetter. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Yes, as of July 16, 2024 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary 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.

The provider has an overall high rating in the following quality measures: quality clinical practices and patient outcomes and experiences.

Medicare beneficiaries should expect a typical cost of $87.96 with an average copayment of $21.99 for new patient appointments. Established patients should expect a typical charge of $101.62 and an average copayment of 25.4. Please review your insurance plan or contact the provider directly to determine your specific costs.

The most common procedures or services performed by this practitioner are: Cervical or vaginal cancer screening; pelvic and clinical breast examination and Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory.

The practitioner is affiliated to the following hospital(s): UPMC KANE and PENN HIGHLANDS ELK. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

This NPI record was last updated on January 09, 2020. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.