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DR. BRIAN E MICHAEL MD
NPI 1942237722
Internal Medicine - Endocrinology, Diabetes & Metabolism in Gettysburg, PA

Active since June 27, 2006PECOS EnrolledAccepts Medicare Assignment
66.75/100
CMS Quality Rating
20 EXPEDITION TRL, STE 201, GETTYSBURG, PA 17325(316) 644-0318 Get Directions Write a Review

NPPES record last updated: May 6, 2019. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: May 6, 2019, Apr 10, 2019, May 2, 2018 and 1 more (4 updates tracked since 2017).

About Dr. Brian E Michael Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. BRIAN E MICHAEL MD (NPI 1942237722) is an individual endocrinology, diabetes & metabolism provider in Gettysburg, Pennsylvania, licensed in Pennsylvania (MD438989) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS, is affiliated with Wellspan York Hospital, and is a graduate of University Of Connecticut School Of Medicine (1974).

NPPES Registry Identity

NPI1942237722
Entity TypeIndividualMale
Primary Taxonomy207RE0101X
Provider Legal NameDR. BRIAN E MICHAELCredential: MD
Location Address20 EXPEDITION TRL, STE 201Gettysburg, PA 17325-8599
Mailing Address20 Expedition Trl Ste 101Gettysburg, PA 17325-8599 · (717) 287-0430
Phone(316) 644-0318
Sole ProprietorYes
Medical School CMSUniversity Of Connecticut School Of MedicineGraduated 1974
Enumeration DateJune 27, 2006
Last NPPES UpdateMay 6, 20194 updates tracked since enumeration
✔ NPI 1942237722 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Endocrinology, Diabetes & MetabolismAllopathic & Osteopathic Physicians
Taxonomy Code207RE0101X
Licenses✔ Licensed in PA · MD438989✔ Licensed in KS · 30454
Definition
An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems.
20 EXPEDITION TRL, Gettysburg, PA 17325
Open in Google Maps ↗

Other Identifiers 13

Other2154216PA · Highmark Bcbs
Other7316KS · Phs
Other415261PA · Upmc-wmg
Other296111PA · Unison-wmg
Other30076507PA · Amerihealth Mercy-wmg
Other103403KS · Bcbs
Other1213798KS · Multiplan
Other962225MD · Carefirst Md Bcbs
Medicaid1024256670001PA
Other1589950PA · Gateway-wmg
Medicaid200004480AKS
Other207002KS · Hpk
Other187660KS · Coventry

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter Health, Ambetter Health of Delaware.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Brian E Michael Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2668373911
PECOS Enrollment IDI20100409000030
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
759 services373 patients
Continuous monitoring of blood sugar level in tissue fluid using sensor under skin with interpretation and report 95251
This procedure involves placing a small sensor under your skin to continuously monitor your blood sugar levels in tissue fluid. The data is interpreted and a report is generated to help manage your diabetes more effectively.
290 services112 patients
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
211 services145 patients
Ultrasound scan of head and neck soft tissue 76536
An ultrasound scan of the head and neck soft tissue is a non-invasive procedure that uses sound waves to create images of the soft tissues in these areas. It helps identify any abnormalities or issues, such as tumors, cysts, or infections. It's painless and doesn't involve radiation.
136 services124 patients
New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205
This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.
78 services78 patients
Fine needle aspiration biopsy using ultrasound guidance, first growth 10005
Fine needle aspiration biopsy with ultrasound guidance is a procedure where a thin needle is inserted into a growth to extract a small sample. Ultrasound helps accurately locate the growth. This sample is then analyzed to determine the nature of the growth.
12 services12 patients

Hospital Affiliations CMS Care Compare 5

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Wellspan York Hospital

Acute Care Hospitals · York, PA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390046
Location1001 South George StreetYork, PA 17403 · York County
Emergency services Birthing friendly

Gettysburg Hospital

Acute Care Hospitals · Gettysburg, PA
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390065
Location147 Gettys StreetGettysburg, PA 17325 · Adams County
Emergency services Birthing friendly

Wellspan Waynesboro Hospital

Acute Care Hospitals · Waynesboro, PA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390138
Location501 East Main StWaynesboro, PA 17268 · Franklin County
Emergency services

Wellspan Chambersburg Hospital

Acute Care Hospitals · Chambersburg, PA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390151
Location112 North Seventh StreetChambersburg, PA 17201 · Franklin County
Emergency services Birthing friendly

Upmc Hanover

Acute Care Hospitals · Hanover, PA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390233
Location300 Highland AveHanover, PA 17331 · York County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 17325 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$126.34 typical visit price
range $54.64 – $166.87
Typical copayment $31.58 (range $13.66 – $41.71)
Most-billed visit code 99204
Established Patient
$96.82 typical visit price
range $17.33 – $135.84
Typical copayment $24.20 (range $4.33 – $33.96)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

66.75/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Individually scored
Quality74.87
Improvement Activities40
Cost22.69

Reported Quality Measures

Closing the Referral Loop: Receipt of Specialist Report
13%220 patients1/55-star benchmark: 87%
Colorectal Cancer Screening
4%852 patients1/55-star benchmark: 88%
Controlling High Blood Pressure
86%452 patients4/55-star benchmark: 91%
Diabetes: Eye Exam
1%473 patients1/55-star benchmark: 100%
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
Lower rates are better for this measure.
93%473 patients1/55-star benchmark: 91%
Documentation of Current Medications in the Medical Record
100%3,410 patients5/55-star benchmark: 100%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
5%1,429 patients1/55-star benchmark: 98%
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
46%1,962 patients4/55-star benchmark: 61%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Patients screened: 0% · 1,048 patients
0%1,048 patients
Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
76%608 patients3/55-star benchmark: 91%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 6

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Supplies for maintenance of insulin infusion catheter, per week A4224
DME-Other DME · category DE017N
4 suppliers15 claims194 services$18.13 avg. paid by Medicare
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each A4225
DME-Other DME · category DE017N
4 suppliers14 claims490 services$2.35 avg. paid by Medicare
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
7 suppliers35 claims123 services$6.71 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
6 suppliers11 claims20 services$1.15 avg. paid by Medicare
External ambulatory infusion pump, insulin E0784
DME-Other DME · category DE017N
2 suppliers23 claims23 services$297.76 avg. paid by Medicare
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
12 suppliers345 claims352 services$184.59 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VANILLA MANAGEMENT LLC
Clinic/Center (Primary Care)
20 EXPEDITION TRL, SUITE 102
GETTYSBURG, PA 17325
Adams County (717) 515-9652
MONTGOMERY RADIOLOGY ASSOCIATES, PC
Radiology (Diagnostic Radiology)
20 EXPEDITION TRL
GETTYSBURG, PA 17325
Adams County (717) 337-5991
DR. HOWARD IRA SAIONTZ MD
Internal Medicine (Hematology & Oncology)
20 EXPEDITION TRL, SUITE 101
GETTYSBURG, PA 17325
Adams County (717) 334-4033
RENAL TREATMENT CENTERS - MID-ATLANTIC INC
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
20 EXPEDITION TRL, STE 202
GETTYSBURG, PA 17325
Adams County (717) 337-1012
DR. SATISH A SHAH M.D.
Internal Medicine (Hematology & Oncology)
20 EXPEDITION TRL, SUITE 101
GETTYSBURG, PA 17325
Adams County (717) 334-4033
THORACIC & VASCULAR SURGICAL SPECIALTY SERVICES
Specialist
20 EXPEDITION TRL, SUITE 110B
GETTYSBURG, PA 17325
Adams County (443) 676-6505
DR. TINA ASHLEY KHAIR D.O.
Internal Medicine (Hematology & Oncology)
20 EXPEDITION TRL, SUITE 101
GETTYSBURG, PA 17325
Adams County (717) 334-4033
GETTYSBURG RADIATION ONCOLOGY
Radiology (Radiation Oncology)
20 EXPEDITION TRL, SUITE 100
GETTYSBURG, PA 17325
Adams County (717) 337-2101

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brian Michael's NPI number?

The NPI number for Brian Michael is 1942237722. It was assigned to this individual provider in the NPPES registry on June 27, 2006.

Where is Brian Michael located?

Brian Michael practices at 20 Expedition Trl Ste 201, Gettysburg, PA 17325. The listed phone number is (316) 644-0318.

What is Brian Michael's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Endocrinology, Diabetes & Metabolism, with taxonomy code 207RE0101X.

Is Brian Michael enrolled in Medicare?

Yes. Brian Michael is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Brian Michael accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Ambetter from Buckeye Health Plan list Brian Michael as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Brian Michael affiliated with any hospitals?

According to CMS data, Brian Michael is affiliated with Wellspan York Hospital, Gettysburg Hospital, Wellspan Waynesboro Hospital, Wellspan Chambersburg Hospital and Upmc Hanover.

When was this NPI record last updated?

The NPPES record for Brian Michael was last updated on May 6, 2019. NPI Profile syncs with the weekly NPPES data releases published by CMS.