GERGANA T NELSON MD
NPI 1972846954
Internal Medicine - Pulmonary Disease in Oxnard, CA
Active since March 28, 2013PECOS EnrolledAccepts Medicare Assignment
100/100
CMS Quality Rating
About Gergana T Nelson Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GERGANA T NELSON MD (NPI 1972846954) is an individual pulmonary disease provider in Oxnard, California, licensed in California (A134750) and active in the NPI registry since March 2013. She is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of University Of California, Geffen School Of Medicine (2013).
NPPES Registry Identity
NPI1972846954
Entity TypeIndividualFemale
Primary Taxonomy207RP1001X
Provider Legal NameGERGANA T NELSONCredential: MD
Location Address1910 OUTLET CENTER DROxnard, CA 93036-0677
Mailing Address1910 Outlet Center DrOxnard, CA 93036-0677 · (805) 485-2400 · Fax (805) 485-3025
Phone(805) 485-2400
Fax(805) 485-3025
Sole ProprietorYes
Medical School CMSUniversity Of California, Geffen School Of MedicineGraduated 2013
Enumeration DateMarch 28, 2013
Last NPPES UpdateMay 24, 2021
NPPES CertifiedMay 24, 2021
✔ NPI 1972846954 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses 3
★ Primary SpecialtyInternal Medicine · Pulmonary DiseaseAllopathic & Osteopathic Physicians
Taxonomy Code207RP1001X
License✔ Licensed in CA · A134750
Definition
An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.
Also ListedInternal MedicineTaxonomy 207R00000X · License A134750 (CA)
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
1910 OUTLET CENTER DR, Oxnard, CA 93036
Other Names 1
Former Name (1)Gerganaa T Tomova
Secondary Practice Locations 2
Location 1757 Westwood PlzLos Angeles, CA 90095-8358 · Phone (310) 825-7375
Location 24000 Calle Tecate Ste 105Camarillo, CA 93012-5283 · Phone (805) 485-2400 · Fax (805) 485-3025
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
Gergana T Nelson 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 ID4385999150
PECOS Enrollment IDI20180619001714
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 10
Services this provider delivered to Medicare fee-for-service patients, from the 2024 & 2026 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, 30-39 minutes 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.
382 services239 patients
Follow-up hospital inpatient care per day, typically 35 minutes 99233
Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.
295 services109 patients
Follow-up hospital inpatient care per day, typically 25 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.
268 services64 patients
Test to determine lung volumes using sensors 94726
This test, called spirometry, measures lung capacity using sensors. You breathe into a mouthpiece attached to a device that records the amount and rate of air you inhale and exhale. It helps diagnose and monitor lung conditions.
147 services145 patients
Test to measure expiratory airflow and volume changes before and after medication administration 94060
This procedure measures how air flows in and out of your lungs. It's done before and after medication to see if the treatment improves your breathing. It's a simple, non-invasive test that involves breathing into a device called a spirometer.
146 services144 patients
Test to examine how well the lungs exchange gases 94729
This is a test called a pulmonary function test, which helps understand the efficiency of your lungs. It measures how much air your lungs can hold, how quickly you can move air in and out of your lungs, and how well your lungs put oxygen into and remove carbon dioxide from your blood.
146 services144 patients
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 93036 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
$140.72 typical visit price
range $62.32 – $185.36
Typical copayment $35.18 (range $15.58 – $46.34)
Most-billed visit code 99204
Established Patient
$108.74 typical visit price
range $20.68 – $151.85
Typical copayment $27.18 (range $5.17 – $37.96)
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.
100/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practiceQuality
100
Promoting Interoperability
100
Improvement Activities
40
Reported Quality Measures
Care Plan
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker…
82%240 patients4/55-star benchmark: 100%
Coronary Artery Disease (CAD): Antiplatelet Therapy
Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease (CAD) seen within a 12 month period who were prescribed aspirin or clopidogrel
91%22 patients4/55-star benchmark: 100%
Documentation of Current Medications in the Medical Record
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.
99%620 patients4/55-star benchmark: 100%
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.
83%173 patients4/55-star benchmark: 100%
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%38 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.
100%152 patients5/55-star benchmark: 100%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
99%333 patients4/55-star benchmark: 100%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
59%27 patients3/55-star benchmark: 100%
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…
20%152 patients1/55-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…
100%152 patients5/55-star benchmark: 79%
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 20
Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.
Tubing with integrated heating element for use with positive airway pressure device A4604
DME-Other DME · category DE001N
3 suppliers49 claims49 services$32.04 avg. paid by Medicare
Full face mask used with positive airway pressure device, each A7030
DME-Other DME · category DE001N
2 suppliers19 claims19 services$66.80 avg. paid by Medicare
Face mask interface, replacement for full face mask, each A7031
DME-Other DME · category DE001N
2 suppliers18 claims54 services$27.41 avg. paid by Medicare
Cushion for use on nasal mask interface, replacement only, each A7032
DME-Other DME · category DE001N
2 suppliers18 claims108 services$15.79 avg. paid by Medicare
Pillow for use on nasal cannula type interface, replacement only, pair A7033
DME-Other DME · category DE001N
2 suppliers13 claims78 services$11.25 avg. paid by Medicare
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034
DME-Other DME · category DE001N
3 suppliers31 claims31 services$42.44 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.
Internal Medicine (Pulmonary Disease)
1910 OUTLET CENTER DR
OXNARD, CA 93036
OXNARD, CA 93036
Internal Medicine (Critical Care Medicine)
1910 OUTLET CENTER DR
OXNARD, CA 93036
OXNARD, CA 93036
Internal Medicine (Critical Care Medicine)
1910 OUTLET CENTER DR
OXNARD, CA 93036
OXNARD, CA 93036
Internal Medicine (Critical Care Medicine)
1910 OUTLET CENTER DR
OXNARD, CA 93036
OXNARD, CA 93036
Internal Medicine (Critical Care Medicine)
1910 OUTLET CENTER DR
OXNARD, CA 93036
OXNARD, CA 93036
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1972846954, enumerated as an "individual" on March 28, 2013.
The provider is located at 1910 OUTLET CENTER DR OXNARD, CA 93036 and the phone number is (805) 485-2400.
Internal Medicine with taxonomy code 207RP1001X and a focus in Pulmonary Disease.
