JAMES D PILKINGTON MD
NPI 1972548147
Surgery in Alma, MI

Q: What is James Pilkington's NPI number?

The NPI number for James Pilkington is 1972548147. It was assigned to this individual provider in the NPPES registry on June 19, 2006.

Q: What is James Pilkington's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Q: When was this NPI record last updated?

The NPPES record for James Pilkington was last updated on May 7, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 19, 2006PECOS EnrolledAccepts Medicare Assignment

72.38/100

CMS Quality Rating

315 E WARWICK DR, STE 3, ALMA, MI 48801(989) 463-6699(989) 466-2574 Get Directions Write a Review

NPPES record last updated: May 7, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About James D Pilkington Md NPPES

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

JAMES D PILKINGTON MD (NPI 1972548147) is an individual surgery provider in Alma, Michigan, licensed in Michigan (4301065547) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS, is affiliated with Mymichigan Medical Center Alma, and is a graduate of Michigan State University College Of Human Medicine (1995).

NPPES Registry Identity

NPI1972548147

Entity TypeIndividualMale

Primary Taxonomy208600000X

Provider Legal NameJAMES D PILKINGTONCredential: MD

Location Address315 E WARWICK DR, STE 3Alma, MI 48801-1083

Mailing Address315 E Warwick Dr, Ste 3Alma, MI 48801-1083 · (989) 463-6699 · Fax (989) 466-2574

Phone(989) 463-6699

Fax(989) 466-2574

Sole ProprietorNo

Medical School CMSMichigan State University College Of Human MedicineGraduated 1995

Enumeration DateJune 19, 2006

Last NPPES UpdateMay 7, 2024

NPPES CertifiedMay 7, 2024

✔ NPI 1972548147 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians

Taxonomy Code208600000X

License✔ Licensed in MI · 4301065547

Definition

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

315 E WARWICK DR, Alma, MI 48801

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Other Identifiers 1

Medicaid4426885MI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, McLaren Health Plan Community and more.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

James D Pilkington 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 ID2567564479

PECOS Enrollment IDI20090623000543

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 13

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 low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

223 services177 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

104 services104 patients

Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239

This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.

50 services50 patients

Removal of polyps or growths of large bowel using an endoscope with mechanical snare 45385

This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.

50 services49 patients

Colorectal cancer screening; colonoscopy on individual at high risk G0105

Colorectal cancer screening, specifically a colonoscopy, is a preventive measure for those at high risk. A thin, flexible tube with a camera inspects the colon to spot any abnormal growths. This test helps detect potential issues early, enhancing the effectiveness of treatment.

47 services47 patients

Diagnostic exam of large bowel using a flexible endoscope 45378

This procedure, known as a colonoscopy, involves using a flexible tube with a light and camera to examine the large intestine. It helps detect any abnormalities such as polyps or inflammation. It's a standard procedure to ensure gut health.

40 services38 patients

Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk G0121

Colorectal cancer screening, such as a colonoscopy, is a preventive measure to detect early signs of cancer in the large intestine. For individuals not at high risk, it's typically recommended at age 50. A small, flexible tube with a camera is used to examine your colon. It's a safe, effective way to catch issues early.

32 services32 patients

Biopsy of large bowel using a flexible endoscope 45380

A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.

30 services30 patients

Diagnostic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43235

This procedure, known as an upper endoscopy, involves inserting a thin, flexible tube with a camera down the throat to examine the esophagus, stomach, and upper small bowel. It helps diagnose conditions like ulcers or inflammation.

26 services26 patients

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

23 services15 patients

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

20 services19 patients

Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

18 services16 patients

Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes 99221

Initial hospital inpatient care refers to the first day of your stay in the hospital. This service typically includes a 30-minute check-up with a healthcare professional. They'll assess your health, discuss your condition, and plan your treatment. It's part of ensuring you receive the best possible care.

13 services13 patients

Hospital Affiliations CMS Care Compare 3

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

Mymichigan Medical Center Alma

Acute Care Hospitals · Alma, MI

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number230030

Location300 E Warwick DrAlma, MI 48801 · Gratiot County

Emergency services Birthing friendly

Mymichigan Medical Center Clare

Acute Care Hospitals · Clare, MI

4/5 CMS rating

OwnershipVoluntary non-profit - Other

CMS Certification Number230180

Location703 N Mcewan StClare, MI 48617 · Clare County

Mymichigan Medical Center Midland

Acute Care Hospitals · Midland, MI

4/5 CMS rating

OwnershipVoluntary non-profit - Other

CMS Certification Number230222

Location4000 Wellness DriveMidland, MI 48670 · Midland County

Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 48801 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

$84.74 typical visit price

range $54.34 – $166.68

Typical copayment $21.18 (range $13.58 – $41.67)

Most-billed visit code 99203

Established Patient

$68.07 typical visit price

range $17.09 – $135.40

Typical copayment $17.01 (range $4.27 – $33.85)

Most-billed visit code 99213

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.

72.38/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

39.6

Improvement Activities

Cost

77.81

Reported Quality Measures

Colorectal Cancer Screening

Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer

64%1,207 patients4/55-star benchmark: 85%

e-Prescribing

At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.

90%197 patients4/55-star benchmark: 100%

Health Information Exchange

The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for…

100%2,574 patients5/55-star benchmark: 96%

Medication Reconciliation

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.

100%2,668 patients5/55-star benchmark: 100%

Patient-Specific Education

The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.

0%1,989 patients1/55-star benchmark: 99%

Provide Patient Access

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…

92%1,989 patients4/55-star benchmark: 100%

Secure Messaging

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…

0%1,989 patients1/55-star benchmark: 59%

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

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

Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape B4035

Other-Enteral and Parenteral · category OB006N

1 supplier21 claims639 services$7.66 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 20

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

KRISTIE ANN THUSS-TRUMAN PA

Physician Assistant

315 E WARWICK DR, SUITE F-1
ALMA, MI 48801

Gratiot County (989) 463-0957

JEFFREY SMITH, MD PC

Specialist

315 E WARWICK DR, #3
ALMA, MI 48801

Gratiot County (989) 463-6699

ALYSSA RAYNE WALWARK

Behavior Technician

315 E WARWICK DR
ALMA, MI 48801

Gratiot County (810) 487-5571

JOSEPH R YACISEN DO PC

Orthopaedic Surgery

315 E WARWICK DR, SUITE B
ALMA, MI 48801

Gratiot County (989) 466-2663

DR. ERNEST A CUDJOE M.D.

Surgery

315 E WARWICK DR, # 3
ALMA, MI 48801

Gratiot County (989) 463-6699

JAMES ELDON WARE D.O.

Orthopaedic Surgery

315 E WARWICK DR, SUITE B
ALMA, MI 48801

Gratiot County (989) 463-2333

COURTNEY ROSS

Behavior Technician

315 E WARWICK DR
ALMA, MI 48801

Gratiot County (989) 285-1490

MYMICHIGAN MEDICAL CENTER ALMA

Internal Medicine (Cardiovascular Disease)

315 E WARWICK DR, SUITE E
ALMA, MI 48801

Gratiot County (989) 466-2877

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 James Pilkington's NPI number?

The NPI number for James Pilkington is 1972548147. It was assigned to this individual provider in the NPPES registry on June 19, 2006.

Where is James Pilkington located?

James Pilkington practices at 315 E Warwick Dr Ste 3, Alma, MI 48801. The listed phone number is (989) 463-6699.

What is James Pilkington's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Is James Pilkington enrolled in Medicare?

Yes. James Pilkington 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 James Pilkington accept?

Health plans from Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, McLaren Health Plan Community and Priority Health list James Pilkington 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 James Pilkington affiliated with any hospitals?

According to CMS data, James Pilkington is affiliated with Mymichigan Medical Center Alma, Mymichigan Medical Center Clare and Mymichigan Medical Center Midland.

When was this NPI record last updated?

The NPPES record for James Pilkington was last updated on May 7, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.