DR. PROSPER ABITBOL DO
NPI 1033108030
Internal Medicine - Gastroenterology in Boca Raton, FL

Medicare Participation & PECOS Enrollment Status

Prosper Abitbol 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.

Prosper Abitbol 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: 7618978545

  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: I20070219000199

  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

Provider Referred Orders for Durable Medical Equipment, Devices & Supplies

The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.

Orthotic Devices

• DME-Orthotic Devices (DF010N)

  Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each (HCPCS:A4407)

  2 DME suppliers used 12 Medicare Claims 260 Services Paid

• DME-Orthotic Devices (DF010N)

  Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each (HCPCS:A4425)

  1 DME suppliers used 11 Medicare Claims 220 Services Paid

Unknown

• Other-Enteral and Parenteral (OB006N)

  Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape (HCPCS:B4034)

  1 DME suppliers used 11 Medicare Claims 324 Services Paid

• Other-Enteral and Parenteral (OB006N)

  Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (HCPCS:B4152)

  1 DME suppliers used 11 Medicare Claims 4601 Services Paid

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.

Balloon dilation of esophagus, stomach, and/or upper small bowel using a flexible endoscope, less than 3.0 cm

This procedure involves using a flexible tube with a camera, called an endoscope, to gently expand narrowed areas in your esophagus, stomach, or upper small bowel. A small balloon is inflated, making it easier for food and liquid to pass through. It's safe and effective.

This service was performed 41 times for 40 patients

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

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.

This service was performed 228 times for 223 patients

Biopsy of large bowel using a flexible endoscope

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.

This service was performed 62 times for 62 patients

Biopsy of lower large bowel using a flexible endoscope

A biopsy of the lower large bowel involves using a flexible tube with a camera (endoscope) to examine this part of your digestive tract. Small tissue samples may be taken for further examination to detect any abnormalities.

This service was performed 15 times for 15 patients

Colonoscopy

A colonoscopy is a medical procedure that allows your doctor to examine your colon (the large intestine). It utilizes a thin, flexible tube with a tiny camera on the end, which is inserted through the rectum. This procedure can help identify issues such as polyps, inflammation, or early signs of cancer. It's usually recommended for people over 50 or those with specific risk factors.

This service was performed for 295 patients

Colorectal cancer screening; colonoscopy on individual at high risk

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.

This service was performed 59 times for 59 patients

Destruction of polyp or growth of large bowel using a flexible endoscope

This procedure involves the removal of a polyp or growth in the large bowel. A flexible endoscope, a thin tube with a camera, is inserted through the rectum to visualize and remove the growth. This helps maintain bowel health and prevent complications.

This service was performed 35 times for 35 patients

Diagnostic exam of posterior opening using an endoscope

This procedure involves using a thin, flexible instrument called an endoscope to examine the posterior opening area. It helps detect any abnormal conditions or issues. It's a safe, routine exam performed by a healthcare professional.

This service was performed 29 times for 28 patients

Diagnostic exam of large bowel using a flexible endoscope

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.

This service was performed 33 times for 33 patients

Established patient office or other outpatient visit, 10-19 minutes

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.

This service was performed 22 times for 15 patients

Established patient office or other outpatient visit, 20-29 minutes

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.

This service was performed 444 times for 343 patients

Established patient office or other outpatient visit, 30-39 minutes

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.

This service was performed 202 times for 179 patients

Follow-up hospital inpatient care per day, typically 25 minutes

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.

This service was performed 108 times for 54 patients

Follow-up hospital inpatient care per day, typically 35 minutes

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.

This service was performed 22 times for 17 patients

Follow-up observation care per day, typically 25 minutes

Follow-up observation care is a daily service where your health progress is monitored for about 25 minutes. It's a routine check to ensure your treatment is effective and to adjust if necessary. It's a crucial part of your healthcare journey.

This service was performed 14 times for 12 patients

Follow-up observation care per day, typically 35 minutes

Follow-up observation care is a daily check-up service that lasts about 35 minutes. It involves monitoring your health progress after a treatment or procedure. The care team assesses your recovery and addresses any concerns or questions you may have.

This service was performed 19 times for 15 patients

Imaging of digestive tract done from the inside of the digestive tract

This procedure, known as an endoscopy, involves a small camera being passed into the digestive tract. It helps doctors to see the inside of your digestive system in detail. This can aid in diagnosing conditions or planning treatments. It's generally safe and can provide valuable information.

This service was performed 12 times for 12 patients

Initial hospital inpatient care per day, typically 50 minutes

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.

This service was performed 26 times for 24 patients

Initial hospital inpatient care per day, typically 70 minutes

Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.

This service was performed 44 times for 43 patients

Initial hospital observation care per day, typically 50 minutes

Initial hospital observation care is a service where healthcare professionals monitor your health for about 50 minutes daily. This helps them understand your condition better, plan treatment, and ensure your safety. It's a routine part of hospital care.

This service was performed 15 times for 15 patients

Initial hospital observation care per day, typically 70 minutes

This service involves a healthcare professional closely monitoring your health condition during your hospital stay. It typically lasts for about 70 minutes each day. This helps in timely detection of any changes in your health, allowing for immediate response and treatment.

This service was performed 27 times for 27 patients

Injection beneath lining of large bowel using a flexible endoscope

This procedure involves a flexible tube, called an endoscope, being inserted into the large bowel. A small needle is then passed through the tube to inject medication under the bowel lining. This is typically done to treat inflammation or bleeding.

This service was performed 13 times for 13 patients

New patient office or other outpatient visit, 30-44 minutes

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.

This service was performed 82 times for 82 patients

New patient office or other outpatient visit, 45-59 minutes

This 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 226 times for 226 patients

Pathology examination of tissue using a microscope, intermediate complexity

A pathology examination of tissue with intermediate complexity involves studying a small sample of your body tissue under a microscope. This helps in identifying any abnormal cells or signs of disease. It's a detailed process requiring expert analysis to ensure accurate results.

This service was performed 1,589 times for 253 patients

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

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.

This service was performed 111 times for 110 patients

Special stained specimen slides to examine tissue including interpretation and report

Special stained specimen slides are used to examine tissue samples. This involves applying special dyes to the tissue, which helps to highlight certain features under a microscope. The findings are then interpreted and a report is provided. This can aid in diagnosing various health conditions.

This service was performed 737 times for 199 patients

Special stained specimen slides to identify organisms including interpretation and report

This service involves coloring specimen slides in a special way to help identify organisms. The colors make different parts of the organism stand out. Afterward, a detailed interpretation and report on the findings are provided.

This service was performed 1,191 times for 188 patients

Stool analysis for blood, by peroxidase activity

A stool analysis for blood, by peroxidase activity, is a test to detect blood in your stool. This test helps identify bleeding in the digestive tract. It involves collecting a stool sample, which is then checked for the presence of blood using a chemical reaction.

This service was performed 29 times for 29 patients

Upper gastrointestinal (GI) endoscopy for acid reflux

An upper GI endoscopy is a procedure to examine your esophagus and stomach using a thin, flexible tube called an endoscope. It helps diagnose conditions like acid reflux by identifying any inflammation or damage. It's generally safe, performed under sedation, and takes about 15-30 minutes.

This service was performed for 389 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $33.89 for a new patient copayment and $25.8 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 33486 ZIP code area.

* 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.

Overall MIPS Quality Performance

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 75, 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 Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS 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.

• Final Score: 75 out of 100

  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 Score: 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 Score: 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 Score: 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 activities measure category compromises 15% providers final MPIS scores.
  
  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 Score: 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.

• Cost Score: 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.

Quality Reporting

The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. 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.

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. Prosper Abitbol is affiliated with the following medical facilities:

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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.

The NPI number 1033108030 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.

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Frequently Asked Questions