BRIAN CULLIGAN O.D. NPI 1942230610
Optometrist in Gallup, NM
About BRIAN CULLIGAN O.D.
Brian Culligan is a provider established in Gallup, New Mexico and his medical specialization is Optometrist. The NPI number of this provider is 1942230610 and was assigned on July 2006. The practitioner's primary taxonomy code is 152W00000X with license number 1930 (CO). The provider is registered as an individual and his NPI record was last updated 15 years ago.
| NPI | 1942230610 |
| Provider Name | BRIAN CULLIGAN O.D. |
| Location Address | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 |
| Location Phone | (505) 722-1000 |
| Mailing Address | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 |
| Gender | Male |
| NPI Entity Type | Individual |
| Is Sole Proprietor? | No |
| Enumeration Date | 07-05-2006 |
| Last Update Date | 04-11-2008 |
Brian Culligan 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) and a Home Health Agency (HHA)..
The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 77.76, 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.
Primary Taxonomy
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.
| Taxonomy Code | 152W00000X |
| Classification | Optometrist |
| Type | Eye and Vision Services Providers |
| License No. | 1930 |
| License State | CO |
| Taxonomy Description | Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
Accepted Insurance
The NPI profile data indicates this provider might be enrolled and accepting health plans from the following insurance companies or healthcare programs:
- Medicaid
- Medicare
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Business Address
516 E. NIZHONI BLVD
BOX 1337
GALLUP, NM
ZIP 87301
Phone: (505) 722-1000
Fax: (505) 722-1747
Mailing Address
516 E. NIZHONI BLVD
BOX 1337
GALLUP, NM
ZIP 87301
Phone: (505) 722-1000
Fax: (505) 722-1747
Location Map
PECOS Enrollment and Medicare Participation Status
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 |
| Eligible order / refer Part B Clinical Laboratory and Imaging | Yes |
| Eligible order / refer Durable Medical Equipment | Yes |
| Eligible order / refer Home Health Agency (HHA) | Yes |
| Eligible order / refer Power Mobility Devices | No |
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 87301 ZIP code area.
| New Patients Office Visits Costs * | ||
|---|---|---|
| Most Utilized Procedure Code for new patients office visits: 99204 | ||
| Minimum New Patient Pricing | Maximum New Patient Pricing | Typical New Patient Pricing |
| $56.4 | $173.32 | $131.08 |
| Minimum New Patient Copayment | Maximum New Patient Copayment | Typical New Patient Copayment |
| $14.1 | $43.33 | $32.77 |
| 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 |
| $17.1 | $141.02 | $70.8 |
| Minimum Established Patient Copayment | Maximum Established Patient Copayment | Typical Established Patient Copayment |
| $4.27 | $35.25 | $17.7 |
* 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% | 73.83 | |
|
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. |
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| 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. |
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| 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. |
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| Cost | 20% | 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. |
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| MIPS Final Score | - | 77.76 | |
| 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. | |||
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 |
|---|---|---|---|
| 8HZ292 | MEDICARE ID-TYPE UNSPECIFIED (04) | TX | HSZ001 |
| 415241 | MEDICAID (05) | AZ | |
| 000S0428 | MEDICAID (05) | NM | |
| H85259 | MEDICARE UPIN (02) | ||
| 8HZ283 | MEDICARE ID-TYPE UNSPECIFIED (04) | TX | HSZ006 |
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. | |||||||||
| 1 | 9 | 4 | 2 | 2 | 3 | 0 | 6 | 1 | 0 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 9 | 8 | 2 | 4 | 3 | 0 | 6 | 2 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 9 + 8 + 2 + 4 + 3 + 0 + 6 + 2 + 24 = 60 | |||||||||
| Step 3: because the number obtained in step 2 ends in zero, the check digit is zero. | |||||||||
| 0 | |||||||||
The NPI number 1942230610 is valid because the calculated check digit 0 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 |
|---|---|---|---|
| 1366427650 | DR. GIENIA LYNCH MD Individual | Obstetrics & Gynecology | 516 E. NIZHONI BLVD GALLUP INDIAN MEDICAL CENTER GALLUP, NM 87301 (505) 722-1000 |
| 1366420747 | EILEEN BIUNNO MD Individual | Radiology (Diagnostic Radiology) | 516 E. NIZHONI BLVD GALLUP, NM 87301 (505) 722-1000 |
| 1376511485 | UMA D DUGGIRALA MD Individual | Family Medicine | 516 E. NIZHONI BLVD GALLUP INDIAN MEDICAL CENTER GALLUP, NM 87301 (505) 722-1000 |
| 1619910080 | EDWARD ROBLES MEDINA MD Individual | Anesthesiology | 516 E. NIZHONI BLVD GALLUP, NM 87301 (505) 722-1000 |
| 1740217793 | KEVIN DON GAINES MD Individual | Family Medicine | 516 E. NIZHONI BLVD GALLUP, NM 87301 (505) 722-1000 |
| 1902833973 | SEYED HESHMAT MORTAZAVI DMD Individual | Dentist | 516 E. NIZHONI BLVD GALLUP, NM 87301 (505) 722-1000 |
| 1063449577 | JOVITO G SABAL D.D.S Individual | Dentist | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 (505) 722-1000 |
| 1740218874 | ANTHONY VITALI DMD Individual | Dentist | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 (505) 722-1000 |
| 1891723748 | STEVEN DEWAYNE FLORER DDS Individual | Dentist | 516 E. NIZHONI BLVD GALLUP, NM 87301 (505) 722-1000 |
| 1184653941 | JEANMAIRE RENE OFFNER M.D. Individual | Internal Medicine | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 (505) 722-1262 |
| 1023048840 | GERI A GOFFE CNM Individual | Registered Nurse | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 (505) 722-1000 |
| 1497785224 | BARBARA A SHEBALA CNP Individual | Nurse Practitioner | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 (505) 722-1000 |
| 1205867603 | GARY A ESCUDERO M.D. Individual | Pediatrics | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 (505) 722-1000 |
| 1629009998 | TERRANCE W SLOAN M.D. Individual | Internal Medicine | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 (505) 722-1000 |
| 1902830037 | DEBORA J RUSSELL M.D. Individual | Obstetrics & Gynecology | 516 E. NIZHONI BLVD BOX 1337 GALLUP, NM 87301 (505) 722-1000 |
| 1528169950 | CHRISTINE CASTILLO RPH Individual | Pharmacist | 516 E. NIZHONI BLVD GALLUP, NM 87301 (505) 722-1185 |
| 1821136573 | DENISE A. NORMAN RPH Individual | Pharmacist | 516 E. NIZHONI BLVD GALLUP INDIAN MEDICAL CENTER (GIMC) GALLUP, NM 87301 (505) 722-1185 |
| 1205960044 | EDWARD T HUI MD Individual | Neurological Surgery | 516 E. NIZHONI BLVD GALLUP, NM 87301 (505) 722-1000 |
| 1003009945 | MRS. SANDRA L SKEETS RN Individual | Registered Nurse (Ambulatory Care) | 516 E. NIZHONI BLVD GALLUP, NM 87301 (505) 722-1000 |
| 1285803577 | MS. DEVON AURORA MCCABE RN Individual | Registered Nurse | 516 E. NIZHONI BLVD GALLUP, NM 87301 (505) 722-1000 |
Frequently Asked Questions
What is Brian Culligan O.D. NPI number?
The NPI number assigned to this healthcare provider is 1942230610, registered as an "individual" on July 05, 2006
Where is Brian Culligan O.D. located?
The provider is located at 516 E. Nizhoni Blvd Box 1337 Gallup, Nm 87301 and the phone number is (505) 722-1000
Which is Brian Culligan O.D. specialty?
The provider's speciality is Optometrist
What insurance does Brian Culligan O.D. accept?
The provider might be accepting Medicaid and Medicare. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Is Brian Culligan O.D. registered in PECOS?
Yes, as of September 14, 2023 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a Medicare beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME) and a Home Health Agency (HHA).
How much is a visit to Brian Culligan O.D.?
Medicare beneficiaries should expect a typical cost of $131.08 with an average copayment of $32.77 for new patient appointments. Established patients should expect a typical charge of $70.8 and an average copayment of 17.7. Please review your insurance plan or contact the provider directly to determine your specific costs.
How do I update my NPI information?
The NPI record of Brian Culligan O.D. was last updated on July 05, 2006. 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].
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