JAMES R GROSS M.D.
NPI 1023082203
Otolaryngology in Mount Vernon, WA
NPI Status: Active since February 15, 2006
Contact Information
118 S 12TH ST
MOUNT VERNON, WA
ZIP 98274
Phone: (360) 336-2178
Fax: (360) 336-1995
- Individual
- Male
- Years of Experience 46
- Otolaryngology
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
About JAMES GROSS
This page provides the complete NPI Profile along with additional information for James Gross, a provider established in Mount Vernon, Washington with a medical specialization in Otolaryngology and more than 46 years of experience. He graduated from University Of Washington School Of Medicine in 1980. The healthcare provider is registered in the NPI registry with number 1023082203 assigned on February 2006. The practitioner's primary taxonomy code is 207Y00000X with license number MD00019697 (WA). The provider is registered as an individual and his NPI record was last updated 4 years ago.
- NPI
- 1023082203
- Provider Name
- JAMES R GROSS M.D.
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 118 S 12TH ST MOUNT VERNON, WA 98274
- Location Phone
- (360) 336-2178
- Location Fax
- (360) 336-1995
- Mailing Address
- 1400 E KINCAID ST MOUNT VERNON, WA 98274
- Mailing Fax
- (360) 336-1995
- Medical School Name
- UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE
- Graduation Year
- 1980
- Is Sole Proprietor?
- No
- Enumeration Date
- 02-15-2006
- Last Update Date
- 10-27-2021
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Otolaryngology
- Taxonomy Code
- 207Y00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- MD00019697
- License State
- WA
- Taxonomy Description
- An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207YS0123X | Allopathic & Osteopathic Physicians | Otolaryngology | MD00019697 (WA) |
| 2 | 207YX0602X | Allopathic & Osteopathic Physicians | Otolaryngology | MD00019697 (WA) |
| 3 | 207YX0905X | Allopathic & Osteopathic Physicians | Otolaryngology | MD00019697 (WA) |
| 4 | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | MD00019697 (WA) |
| 5 | 2082S0099X | Allopathic & Osteopathic Physicians | Plastic Surgery | MD00019697 (WA) |
| 6 | 208600000X | Allopathic & Osteopathic Physicians | Surgery | MD00019697 (WA) |
| 7 | 2086S0122X | Allopathic & Osteopathic Physicians | Surgery | MD00019697 (WA) |
| 8 | 2086X0206X | Allopathic & Osteopathic Physicians | Surgery | MD00019697 (WA) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Navigator Bronze 7000 Exchange - PPO
- Navigator Bronze 9200 - PPO
- Navigator Bronze HSA 8050 - PPO
- Navigator Gold 1500 - PPO
- Navigator Gold 1500 Exchange - PPO
- Navigator Gold 500 Exchange - PPO
- Navigator Silver 3500 Exchange - PPO
- Navigator Silver 4000 Exchange - PPO
- Navigator Silver 5000 - PPO
- Navigator Silver HSA 3500 - PPO
- Navigator Standard Expanded Bronze - PPO
- Navigator Standard Gold - PPO
- Navigator Standard Silver - PPO
- PacificSource Oregon Standard Bronze Plan NAV - PPO
- PacificSource Oregon Standard Gold Plan NAV - PPO
- PacificSource Oregon Standard Silver Plan NAV - PPO
- Premera Blue Cross Alaska One Gold - PPO
- Premera Blue Cross Preferred Bronze 5800 HSA - PPO
- Premera Blue Cross Preferred Bronze 6350 - PPO
- Premera Blue Cross Preferred Gold 1500 - PPO
- Premera Blue Cross Preferred Silver 4500 - PPO
- Premera Blue Cross Standard Bronze II - PPO
- Premera Blue Cross Standard Gold - PPO
- Premera Blue Cross Standard Silver - PPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medicare Participation & PECOS Enrollment Status
James Gross is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.
James Gross 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.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
PECOS PAC ID: 5092839415
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20100907000830
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.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 to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Destruction of precancer skin growth, 1 growth
Destruction of precancer skin growth, 2-14 growths
Diagnostic exam of nasal passages using an endoscope
Diagnostic exam of voice box using a flexible endoscope
Established patient office or other outpatient visit, 10-19 minutes
Established patient office or other outpatient visit, 20-29 minutes
Established patient office or other outpatient visit, 30-39 minutes
Exam of ear using a microscope
Injection of drug or substance under skin or into muscle
Injection, triamcinolone acetonide, not otherwise specified, 10 mg
Melanoma (skin cancer) excision
New patient office or other outpatient visit, 30-44 minutes
New patient office or other outpatient visit, 45-59 minutes
Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional
Professional service for multiple injections of allergen
Professional service for preparation and provision of 1 or more antigens
Professional service for single injection of allergen
Removal of impacted ear wax
Simple control of nose bleed
Test for allergy using allergenic extract
Test for allergy using allergenic extract injected into skin
"Destruction of precancer skin growth" is a procedure that eliminates a single precancerous skin growth. This is done to prevent it from developing into skin cancer. The growth may be removed using various methods such as cryotherapy (freezing), laser therapy, or topical medications.
This service was performed 44 times for 29 patientsThis procedure involves removing 2-14 precancerous skin growths. The growths are treated to prevent them from potentially developing into skin cancer. The process is safe, with minimal discomfort, and promotes healthier skin.
This service was performed 73 times for 24 patientsA diagnostic exam of nasal passages using an endoscope is a non-invasive procedure. A small, flexible tube with a light and camera at the end, called an endoscope, is inserted into the nose. This allows the doctor to view the nasal passages and sinuses, helping to identify any issues.
This service was performed 21 times for 17 patientsThis procedure involves a doctor examining your voice box using a flexible endoscope, a thin tube with a light and camera. It's inserted through your nose or mouth to visualize your throat area. It helps detect any abnormalities in your voice box, ensuring optimal vocal health.
This service was performed 35 times for 27 patientsThis 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.
This service was performed 77 times for 64 patientsThis 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.
This service was performed 361 times for 247 patientsThis 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.
This service was performed 22 times for 22 patientsAn exam of the ear using a microscope allows a detailed view of the ear structures. This non-invasive procedure helps identify issues such as infections, blockages, or ear damage. It's a safe, quick, and painless way to evaluate ear health.
This service was performed 56 times for 44 patientsThis procedure involves administering medication directly under the skin or into a muscle. A small needle is used to inject the drug, allowing it to be absorbed quickly into the bloodstream. It's a common method for delivering a variety of medications.
This service was performed 13 times for 12 patientsTriamcinolone acetonide is a medication used to reduce inflammation in the body. It's given as a 10 mg injection for conditions like allergies, arthritis, or skin problems. The injection helps to decrease swelling, redness, and itching.
This service was performed 104 times for 16 patientsMelanoma excision is a procedure where a surgeon removes melanoma, a type of skin cancer, and some surrounding healthy tissue. Local anesthesia is applied to numb the area. The goal is to completely remove the cancer and prevent its spread. Healing time varies.
This service was performed for 1-10 patientsThis 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.
This service was performed 80 times for 80 patientsThis is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
This service was performed 97 times for 97 patientsThis service involves an outpatient visit for established patients who may not need direct interaction with a healthcare professional. It could include reviewing test results, monitoring existing conditions, or adjusting treatment plans. It's typically done remotely, ensuring your comfort and convenience.
This service was performed 32 times for 29 patientsThe professional service for multiple injections of allergens involves administering small doses of specific allergens into your body. This is done to help your immune system become less sensitive to them, reducing your allergic reaction over time. It's a safe, effective way to manage allergies.
This service was performed 253 times for 42 patientsThis service involves the creation and supply of antigens, substances that stimulate your immune system to fight diseases. These antigens can be used in vaccines or allergy tests to help your body build defenses against specific health threats.
This service was performed 675 times for 35 patientsA single allergen injection is a procedure where a small amount of a specific allergen is injected into your body. This is done to test your body's reaction to the allergen or to help your immune system become less sensitive to it, reducing allergic symptoms.
This service was performed 487 times for 44 patientsImpacted ear wax removal is a safe procedure to clear blockages in the ear canal caused by hardened ear wax. A healthcare professional uses specialized tools or a gentle irrigation method to loosen and remove the wax, improving hearing and alleviating discomfort.
This service was performed 202 times for 161 patientsSimple control of a nose bleed involves leaning forward slightly to prevent blood from flowing down the throat. Pinch your nostrils together and breathe through your mouth. This pressure can help the blood clot and stop the bleeding. Avoid lying down or blowing your nose.
This service was performed 16 times for 15 patientsAn allergy test with allergenic extract is a diagnostic method to identify substances causing allergic reactions. Small amounts of common allergens are introduced to your body, usually through skin pricks or blood tests. Your body's response helps determine your allergies.
This service was performed 1,163 times for 36 patientsAn allergy skin test involves injecting a small amount of allergenic extract into your skin. This test helps determine if you're allergic to specific substances. If allergic, a small red bump appears at the test site. It's safe and quick.
This service was performed 1,067 times for 34 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $32.74 for a new patient copayment and $17.82 for an established patient copayment.
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 98274 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $130.99
- Minimum New Patient Price $57.27
- Maximum New Patient Price $172.8
- Average New Patient Copayment $32.74
- Minimum New Patient Copayment $14.31
- Maximum New Patient Copayment $43.2
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $71.29
- Minimum Established Patient Price $18.56
- Maximum Established Patient Price $141.11
- Average Established Patient Copayment $17.82
- Minimum Established Patient Copayment $4.64
- Maximum Established Patient Copayment $35.27
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Find Provider Hospital Affiliations - Privileges
Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.
Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical 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. James Gross is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| SKAGIT VALLEY HOSPITAL | 1415 E KINCAID STREET MOUNT VERNON, WA 98274 | (360) 424-4111 | Acute Care Hospitals |
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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 | 0 | 2 | 3 | 0 | 8 | 2 | 2 | 0 | 3 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 0 | 4 | 3 | 0 | 8 | 4 | 2 | 0 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 0 + 4 + 3 + 0 + 8 + 4 + 2 + 0 + 24 = 47 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 50 - 47 = 3 | 3 | ||||||||
The NPI number 1023082203 is valid because the calculated check digit 3 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 8 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1255456588 | MARY ANN WOOD Individual | Audiologist-Hearing Aid Fitter | 118 S 12TH ST MOUNT VERNON, WA 98274 (360) 336-2178 |
| 1730488693 | CASCADE AUDIOLOGY AND HEARING AID CENTER PLLC Organization | Clinic/Center (Hearing and Speech) | 118 S 12TH ST MOUNT VERNON, WA 98274 (360) 336-2178 |
| 1104073170 | DR. CHRISTOPHER RAY ENGLAND M.D. Individual | Otolaryngology | 118 S 12TH ST MOUNT VERNON, WA 98274 (360) 336-2178 |
| 1295706752 | GARY L BROWN M.D. Individual | Otolaryngology | 118 S 12TH ST MOUNT VERNON, WA 98274 (360) 336-2178 |
| 1437129186 | GARY K JOHNSON M.D. Individual | Otolaryngology | 118 S 12TH ST MOUNT VERNON, WA 98274 (360) 336-2178 |
| 1376209478 | RYAN DAVID TOERING PA-C Individual | Physician Assistant (Surgical) | 118 S 12TH ST MOUNT VERNON, WA 98274 (360) 336-2178 |
| 1699366336 | DR. HANNAH JULIA CARLSON AU.D. Individual | Audiologist | 118 S 12TH ST MOUNT VERNON, WA 98274 (360) 336-2178 |
| 1174029078 | DR. MICHAEL BRYAN MULLEN MD Individual | Otolaryngology | 118 S 12TH ST MOUNT VERNON, WA 98274 (360) 336-2178 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1023082203, enumerated in the NPI registry as an "individual" on February 15, 2006
The provider is located at 118 S 12th St Mount Vernon, Wa 98274 and the phone number is (360) 336-2178
The provider's speciality is Otolaryngology with taxonomy code 207Y00000X
The provider has more than 46 years of experience. He graduated from University Of Washington School Of Medicine in 1980.
The provider might be accepting Accepts: PacificSource Health Plans and Premera Blue Cross. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary 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.
Medicare beneficiaries should expect a typical cost of $130.99 with an average copayment of $32.74 for new patient appointments. Established patients should expect a typical charge of $71.29 and an average copayment of 17.82. Please review your insurance plan or contact the provider directly to determine your specific costs.
The most common procedures or services performed by this practitioner are: Destruction of precancer skin growth, 1 growth, Destruction of precancer skin growth, 2-14 growths, Diagnostic exam of nasal passages using an endoscope, Diagnostic exam of voice box using a flexible endoscope, Established patient office or other outpatient visit, 10-19 minutes, Established patient office or other outpatient visit, 20-29 minutes, Established patient office or other outpatient visit, 30-39 minutes, Exam of ear using a microscope, Injection of drug or substance under skin or into muscle, Injection, triamcinolone acetonide, not otherwise specified, 10 mg, Melanoma (skin cancer) excision, New patient office or other outpatient visit, 30-44 minutes, New patient office or other outpatient visit, 45-59 minutes, Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional, Professional service for multiple injections of allergen, Professional service for preparation and provision of 1 or more antigens, Professional service for single injection of allergen, Removal of impacted ear wax, Simple control of nose bleed, Test for allergy using allergenic extract and Test for allergy using allergenic extract injected into skin.
The practitioner is affiliated to the following hospital(s): SKAGIT VALLEY HOSPITAL. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
This NPI record was last updated on February 15, 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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