IDRIS GHARBAOUI M.D. NPI 1992731392

Orthopaedic Surgery in Houston, TX

NPI 1992731392 Individual Male Years of Experience 36 Orthopaedic Surgery PECOS Enrolled Accepts Medicare Approved Payment MIPS Quality Score 30 Medicare Quality Reporting

NPI Profile for IDRIS GHARBAOUI M.D.

Idris Gharbaoui is a provider established in Houston, Texas and his medical specialization is orthopaedic surgery with more than 36 years of experience. The NPI number of Idris Gharbaoui is 1992731392 and was assigned on June 2006. The practitioner's primary taxonomy code is 207X00000X with license number M0087 (TX). The provider is registered as an individual and his NPI record was last updated 9 years ago.

Idris Gharbaoui 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.

Idris Gharbaoui is registered with Medicare and accepts claims assignment, this means the provider accepts Medicare's approved amount for the cost of rendered services as full payment. Participating providers may not charge Medicare beneficiaries more than Medicare's approved amount for their services. Medicare beneficiaries still have to pay a coinsurance or copayment amount for a visit or service. According to Medicare claims data he has hospital affiliations with Texas Orthopedic Hospital.

The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 30, 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 following quality measures were reported for this provider: documentation of current medications in the medical record, engagement of patients through implementation of improvements in patient portal, e-prescribing, falls: screening for future fall risk, improved practices that engage patients pre-visit, medication reconciliation, patient-specific education, preventive care and screening: body mass index (bmi) screening and follow-up plan, provide 24/7 access to mips eligible clinicians or groups who have real-time access to patient's medical record, provide patient access, secure messaging, security risk analysis and use of high-risk medications in the elderly.

The typical physician office visit costs for Medicare beneficiaries in this area are: $23.3 for a new patient copayment and $18.96 for an established patient copayment.

NPI

1992731392

Provider Name IDRIS GHARBAOUI M.D.
Provider Location Address7401 S. MAIN HOUSTON, TX 77030
Provider Mailing Address7401 S. MAIN HOUSTON, TX 77030
GenderMale
NPI Entity TypeIndividual
Medical School NameOTHER
Graduation Year1987
Is Sole Proprietor?Yes
Is Organization Subpart?N/A
Enumeration Date06-25-2006
Last Update Date05-16-2013


Primary Taxonomy

Taxonomy Code207X00000X
ClassificationOrthopaedic Surgery
TypeAllopathic & Osteopathic Physicians
License No.M0087
License StateTX
Taxonomy DescriptionAn orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.

Business Address

IDRIS GHARBAOUI M.D.
7401 S. MAIN
HOUSTON, TX
ZIP 77030
Phone: (713) 799-2300
Fax: (713) 794-3380

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Mailing Address

IDRIS GHARBAOUI M.D.
7401 S. MAIN
HOUSTON, TX
ZIP 77030
Phone: (713) 799-2300
Fax: (713) 794-3380



PECOS Enrollment and Medicare Participation

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
PECOS PAC ID345210597
PECOS Enrollment IDI20040727000800
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 order / refer Part B Clinical Laboratory and ImagingYes
Eligible order / refer Durable Medical EquipmentYes
Eligible order / refer Home Health Agency (HHA)Yes
Eligible order / refer Power Mobility DevicesYes

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 77030 ZIP code area.

New Patients Office Visits Costs *
Most Utilized Procedure Code for new patients office visits: 99203
Minimum New Patient Pricing Maximum New Patient Pricing Typical New Patient Pricing
$60.64 $183.87 $93.23
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$15.16 $45.96 $23.3
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
$18.93 $150.28 $75.86
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$4.73 $37.57 $18.96

* 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% N/A
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 (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.
Improvement Activities 15% N/A
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.
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.
MIPS Final Score - 30
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 Reporting

The following quality measures meet Medicare's statistical reporting standards for the year 2018. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

Quality Measure Performance Number of Patients
Documentation of Current Medications in the Medical Record 99% 1558
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. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration
Engagement of patients through implementation of improvements in patient portalYesN/A
Access to an enhanced patient portal that provides up to date information related to relevant chronic disease health or blood pressure control, and includes interactive features allowing patients to enter health information and/or enables bidirectional communication about medication changes and adherence.
e-Prescribing 87% 203
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Falls: Screening for Future Fall Risk 2% 125
Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period
Improved Practices that Engage Patients Pre-VisitYesN/A
Implementation of workflow changes that engage patients prior to the visit, such as a pre-visit development of a shared visit agenda with the patient, or targeted pre-visit laboratory testing that will be resulted and available to the MIPS eligible clinician to review and discuss during the patient’s appointment..
Medication Reconciliation 97% 1082
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.
Patient-Specific Education 0% 1156
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.
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 29% 683
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 twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2
Provide 24/7 Access to MIPS Eligible Clinicians or Groups Who Have Real-Time Access to Patient's Medical RecordYesN/A
• Provide 24/7 access to MIPS eligible clinicians, groups, or care teams for advice about urgent and emergent care (e.g., MIPS eligible clinician and care team access to medical record, cross-coverage with access to medical record, or protocol-driven nurse line with access to medical record) that could include one or more of the following: • Expanded hours in evenings and weekends with access to the patient medical record (e.g., coordinate with small practices to provide alternate hour office visits and urgent care); • Use of alternatives to increase access to care team by MIPS eligible clinicians and groups, such as e-visits, phone visits, group visits, home visits and alternate locations (e.g., senior centers and assisted living centers); and/or Provision of same-day or next-day access to a consistent MIPS eligible clinician, group or care team when needed for urgent care or transition management.
Provide Patient Access 55% 1156
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 certain information.
Secure Messaging 59% 1156
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 message sent by the patient (or the patient-authorized representative) during the performance period.
Security Risk AnalysisYesN/A
Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.
Use of High-Risk Medications in the Elderly 6% "Inverse Quality Measure"
This is an inverse quality measure, a lower rate means the provider is rated better.
125
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication. 2) Percentage of patients who were ordered at least two of the same high-risk medication

Clinician Utilization

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 2017. The reported codes are based on the top 5 codes for each available Medicare specialty, excluding evaluation and management codes.

  • 30X-ray of fingers, minimum of 2 views (HCPCS:73140)
  • 17X-ray of hand, minimum of 3 views (HCPCS:73130)

Hospital Affiliations

Medicare hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the Medicare 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. Idris Gharbaoui is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
TEXAS ORTHOPEDIC HOSPITAL7401 SOUTH MAIN STREET
HOUSTON, TX 77030
(713) 799-8600Acute Care Hospitals450804

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
8L19368MEDICARE PIN (08)TX

NPI Validation Check Digit Calculation


The following table explains step by step the 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.
1992731392
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
291821432318
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 9 + 1 + 8 + 2 + 1 + 4 + 3 + 2 + 3 + 1 + 8 + 24 = 68
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 68 = 22

The NPI number 1992731392 is valid because the calculated check digit 2 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
1376531954 HUSSEIN A ELKOUSY M.D.
Individual
Orthopaedic Surgery7401 S. MAIN
HOUSTON, TX 77030
(713) 799-2300
1952399347DR. ALAN E HEILMAN M.D.
Individual
Orthopaedic Surgery (Orthopaedic Surgery of the Spine)7401 S. MAIN
HOUSTON, TX 77030
(713) 799-2300
1689664732 SONIA LYNN RICH R.N.F.A.,O.P.A.C.
Individual
Registered Nurse (Orthopedic)7401 S. MAIN
HOUSTON, TX 77030
(713) 799-2300
1376585851 YOMNA T MONLA M.D.
Individual
Internal Medicine (Endocrinology, Diabetes & Metabolism)7401 S. MAIN
HOUSTON, TX 77030
(713) 799-2300
1013021534 KAREN ANN GUNTER P.A.
Individual
Physician Assistant (Surgical)7401 S. MAIN
HOUSTON, TX 77030
(713) 799-2300
1003000738 JULIETTE A. ZUMWALT P.A.
Individual
Physician Assistant7401 S. MAIN
HOUSTON, TX 77030
(713) 799-2300
1881865574 JOHN O BISHOP M.D.
Individual
Orthopaedic Surgery (Foot and Ankle Surgery)7401 S. MAIN
HOUSTON, TX 77030
(713) 794-3339
1518100684 CHARLES E BAKER M.D.
Individual
Orthopaedic Surgery7401 S. MAIN
HOUSTON, TX 77030
(713) 799-2300
1164721460 ALISHA SMITH PTA
Individual
Physical Therapist7401 S. MAIN
HOUSTON, TX 77030
(713) 799-2300
1376832329 SAMANTHA NEDELMAN LEE P.A.
Individual
Physician Assistant7401 S. MAIN
HOUSTON, TX 77030
(713) 799-2300
1063797538 BABAK SHERKAT R.N.
Individual
Registered Nurse7401 S. MAIN
HOUSTON, TX 77030
(713) 799-2300
1831466820 NIZAR MOUGHRABI NP, RN
Individual
Nurse Practitioner (Family)7401 S. MAIN FONDREN ORTHOPEDIC GROUP L.L.P.
HOUSTON, TX 77030
(713) 799-2300
1467782284MR. STEVEN RAMON GOLDHOFF P.A.-C
Individual
Physician Assistant7401 S. MAIN FONDREN ORTHOPEDIC GROUP L.L.P.
HOUSTON, TX 77030
(713) 799-2300
1649372962 DAVID M BLOOME M.D.
Individual
Orthopaedic Surgery7401 S. MAIN
HOUSTON, TX 77030
(713) 799-2300
1346581469 DARREN DOWNING GORE PA
Individual
Physician Assistant7401 S. MAIN FONDREN ORTHOPEDIC GROUP L.L.P.
HOUSTON, TX 77030
(713) 799-2300
1396044798 SARAH ZAPALAC REBER P.A.
Individual
Physician Assistant7401 S. MAIN
HOUSTON, TX 77030
(713) 799-2300
1396154928 DEE PITTS R.N.
Individual
Registered Nurse7401 S. MAIN
HOUSTON, TX 77030
(713) 799-2300
1528088622 ARTHUR F. CHAU MD
Individual
Orthopaedic Surgery7401 S. MAIN FONDREN ORTHOPEDIC GROUP L.L.P.
HOUSTON, TX 77030
(713) 799-2300
1912283870MRS. KATHERINE BELL LOVERIN P.A.-C.
Individual
Physician Assistant (Surgical)7401 S. MAIN
HOUSTON, TX 77030
(713) 799-2300
1851364327 SEEMA SHAH M.D.
Individual
Internal Medicine (Infectious Disease)7401 S. MAIN
HOUSTON, TX 77030
(713) 799-2300

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
Idris Gharbaoui M.d. is registered as an entity type code: 1. The entity type code describes the type of health care provider that is being assigned an NPI. The entity type codes are:

  • 1 = Person: individual human being who furnishes health care.
  • 2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
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.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.