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SHABBIR KHAMBATI MD
NPI 1104938257
Ophthalmology in Clinton Twp, MI


Quality Rating: 93.01 out of 100 score

NPI Status: Active since August 31, 2006

Contact Information

35426 HARPER AVE
CLINTON TWP, MI
ZIP 48035
Phone: (586) 792-3891

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Table of Contents

  1. NPI Profile Information
  2. Primary Taxonomy
  3. Insurance Plans Accepted
  4. Medicare Participation & PECOS Status
  5. Areas of Expertise
  6. Physician Visit Costs
  7. Overall Quality Performance
  8. Quality Reporting
  9. NPI Validation
  10. Other Providers Same Location
  11. Frequently Asked Questions
  • Individual
  • Male
  • Years of Experience 29
  • Ophthalmology
  • Accepts Insurance
  • Accepts Medicare Approved Payment
  • PECOS Enrolled
  • Medicare Quality Reporting

About SHABBIR KHAMBATI

This page provides the complete NPI Profile along with additional information for Shabbir Khambati, a provider established in Clinton Twp, Michigan with a medical specialization in Ophthalmology and more than 29 years of experience. He graduated from Wayne State University School Of Medicine in 1997. The healthcare provider is registered in the NPI registry with number 1104938257 assigned on August 2006. The practitioner's primary taxonomy code is 207W00000X with license number 4301070791Q (MI). The provider is registered as an individual and his NPI record was last updated 9 years ago.

NPI
1104938257
Provider Name
SHABBIR KHAMBATI MD
Gender
Male
Entity Type
Individual
Location Address
35426 HARPER AVE CLINTON TWP, MI 48035
Location Phone
(586) 792-3891
Mailing Address
35776 HARPER AVE CLINTON TWP, MI 48035
Mailing Phone
(586) 792-3891
Medical School Name
WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Graduation Year
1997
Is Sole Proprietor?
Yes
Enumeration Date
08-31-2006
Last Update Date
05-11-2016
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Ophthalmologists like Shabbir Khambati specialize in diagnosing and treating eye conditions. They may perform surgeries to correct vision issues or prevent vision loss due to diseases like glaucoma. Additionally, they can provide eyeglasses, prescribe contact lenses, and offer other vision-related services.

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

Ophthalmology

Taxonomy Code
207W00000X
Type
Allopathic & Osteopathic Physicians
License No.
4301070791Q
License State
MI
Taxonomy Description
An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Ambetter from Meridian

  • Clear Silver - HMO
  • Elite Bronze - HMO
  • Elite Bronze + Vision + Adult Dental - HMO
  • Elite Gold - HMO
  • Elite Gold + Vision + Adult Dental - HMO
  • Everyday Bronze - HMO
  • Everyday Bronze + Vision + Adult Dental - HMO
  • Everyday Gold - HMO
  • Everyday Gold + Vision + Adult Dental - HMO
  • Focused Silver - HMO
  • Focused Silver + Vision + Adult Dental - HMO
  • Standard Expanded Bronze - HMO
  • Standard Expanded Bronze + Vision + Adult Dental - HMO
  • Standard Gold - HMO
  • Standard Gold + Vision + Adult Dental - HMO
  • Standard Silver - HMO
  • Standard Silver + Vision + Adult Dental - HMO

Ambetter Health

  • Choice Bronze HSA - HMO
  • Choice Bronze HSA + Vision + Adult Dental - HMO
  • Clear Gold - HMO
  • Clear Gold + Vision + Adult Dental - HMO
  • Clear Silver - HMO
  • Complete Gold - HMO
  • Complete Gold + Vision + Adult Dental - HMO
  • Complete Silver - HMO
  • Complete Silver + Vision + Adult Dental - HMO
  • Elite Gold - HMO
  • Elite Gold + Vision + Adult Dental - HMO
  • Everyday Bronze - HMO
  • Everyday Bronze + Vision + Adult Dental - HMO
  • Focused Silver - HMO
  • Focused Silver + Vision + Adult Dental - HMO
  • Standard Expanded Bronze - HMO
  • Standard Expanded Bronze + Vision + Adult Dental - HMO
  • Standard Gold - HMO
  • Standard Gold + Vision + Adult Dental - HMO
  • Standard Silver - HMO

Blue Care Network of Michigan

  • Blue Cross� Metro Detroit HMO Bronze Extra - HMO
  • Blue Cross� Metro Detroit HMO Silver Extra - HMO
  • Blue Cross� Preferred HMO Bronze Extra - HMO
  • Blue Cross� Preferred HMO Bronze Saver HSA - HMO
  • Blue Cross� Preferred HMO Bronze Secure - HMO
  • Blue Cross� Preferred HMO Gold - HMO
  • Blue Cross� Preferred HMO Gold Extra - HMO
  • Blue Cross� Preferred HMO Silver - HMO
  • Blue Cross� Preferred HMO Silver Extra - HMO
  • Blue Cross� Preferred HMO Silver Saver - HMO
  • Blue Cross� Preferred HMO Value - HMO
  • Blue Cross� Select HMO Bronze Extra - HMO
  • Blue Cross� Select HMO Bronze Saver HSA - HMO
  • Blue Cross� Select HMO Bronze Secure - HMO
  • Blue Cross� Select HMO Silver - HMO
  • Blue Cross� Select HMO Silver Extra - HMO
  • Blue Cross� Select HMO Silver Saver - HMO
  • Blue Cross� Select HMO Value - HMO

Blue Cross and Blue Shield of Illinois

  • Blue Choice Preferred Bronze PPO? 201 - PPO
  • Blue Choice Preferred Bronze PPO? 701 - PPO
  • Blue Choice Preferred Bronze PPO? Standard - Select Rx Copays - PPO
  • Blue Choice Preferred Gold PPO? 204 - PPO
  • Blue Choice Preferred Gold PPO? Standard - Rx Copays - PPO
  • Blue Choice Preferred Security PPO? 200 - PPO
  • Blue Choice Preferred Silver PPO? 203 - PPO
  • Blue Choice Preferred Silver PPO? 801 - PPO
  • Blue Choice Preferred Silver PPO? Standard - Select Rx Copays - PPO
  • Blue Precision Bronze HMO? 205 - HMO
  • Blue Precision Bronze HMO? 701 - HMO
  • Blue Precision Bronze HMO? Standard - Select Rx Copays - HMO
  • Blue Precision Gold HMO? 207 - HMO
  • Blue Precision Gold HMO? 703 - HMO
  • Blue Precision Gold HMO? Standard - Rx Copays - HMO
  • Blue Precision Silver HMO? 206 - HMO
  • Blue Precision Silver HMO? 704 - HMO
  • Blue Precision Silver HMO? Standard - Select Rx Copays - HMO
  • BlueCare Direct Bronze? Standard - Select Rx Copays with Advocate - HMO
  • BlueCare Direct Gold? Standard - Rx Copays with Advocate - HMO

Blue Cross and Blue Shield of Louisiana

  • Blue Max 70/50 $6700 - PPO
  • Blue Max 90/70 $1500 - PPO
  • Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $3300 - PPO
  • Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan - PPO
  • Blue Max Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan - PPO
  • Blue Max Copay (PCP, Specialist, Urgent Care) 75/55 $1500 Standardized Plan - PPO
  • Blue Saver 60/40 $6100 - PPO
  • Blue Saver 90/70 $3200 - PPO

Blue Cross and Blue Shield of Montana

  • Blue Focus Bronze POS? 205 - POS
  • Blue Focus Bronze POS? 705 - POS
  • Blue Focus Bronze POS? Standard - POS
  • Blue Focus Gold POS? 207 - POS
  • Blue Focus Gold POS? Standard - POS
  • Blue Focus Silver POS? 206 - POS
  • Blue Focus Silver POS? Standard - POS
  • Blue Preferred Bronze PPO? 201 - PPO
  • Blue Preferred Bronze PPO? 202 - PPO
  • Blue Preferred Bronze PPO? Standard - PPO
  • Blue Preferred Gold PPO? 204 - PPO
  • Blue Preferred Gold PPO? Standard - PPO
  • Blue Preferred Security PPO? 200 - PPO
  • Blue Preferred Silver PPO? 203 - PPO
  • Blue Preferred Silver PPO? 308 - PPO
  • Blue Preferred Silver PPO? Standard - PPO

Blue Cross and Blue Shield of Oklahoma

  • Blue Advantage Bronze PPO? 202 - PPO
  • Blue Advantage Bronze PPO? 203 - PPO
  • Blue Advantage Bronze PPO? Standard - PPO
  • Blue Advantage Gold PPO? 309 - PPO
  • Blue Advantage Gold PPO? 604 - PPO
  • Blue Advantage Gold PPO? Standard - PPO
  • Blue Advantage Silver PPO? 204 - PPO
  • Blue Advantage Silver PPO? 501 - PPO
  • Blue Advantage Silver PPO? Standard - PPO
  • Blue Preferred Bronze PPO? Standard - PPO
  • Blue Preferred Gold PPO? Standard - PPO
  • Blue Preferred Security PPO? 200 - PPO
  • Blue Preferred Silver PPO? Standard - PPO
  • MyBlue Gold HMO? 704 - HMO
  • MyBlue Gold HMO? 804 - HMO
  • MyBlue Gold HMO? Standard - HMO
  • MyBlue Silver HMO? 705 - HMO
  • MyBlue Silver HMO? 803 - HMO
  • MyBlue Silver HMO? Standard - HMO

Blue Cross and Blue Shield of Texas

  • Blue Advantage Bronze HMO? 204 - HMO
  • Blue Advantage Bronze HMO? 301 - HMO
  • Blue Advantage Bronze HMO? Standard - HMO
  • Blue Advantage Gold HMO? 206 - HMO
  • Blue Advantage Gold HMO? 603 - HMO
  • Blue Advantage Gold HMO? Standard - HMO
  • Blue Advantage Plus Bronze? 303 - POS
  • Blue Advantage Plus Bronze? 305 - POS
  • Blue Advantage Plus Bronze? Standard - POS
  • Blue Advantage Plus Gold? 203 - POS
  • Blue Advantage Plus Gold? 803 - POS
  • Blue Advantage Plus Gold? Standard - POS
  • Blue Advantage Plus Silver? 202 - POS
  • Blue Advantage Plus Silver? 605 - POS
  • Blue Advantage Plus Silver? Standard - POS
  • Blue Advantage Security HMO? 200 - HMO
  • Blue Advantage Silver HMO? 205 - HMO
  • Blue Advantage Silver HMO? 801 - HMO
  • Blue Advantage Silver HMO? Standard - HMO
  • MyBlue Health Bronze? 402 - HMO

Blue Cross Blue Shield of Michigan Mutual Insurance Company

  • Blue Cross� Premier PPO Bronze Extra - PPO
  • Blue Cross� Premier PPO Bronze HSA - PPO
  • Blue Cross� Premier PPO Bronze Secure - PPO
  • Blue Cross� Premier PPO Gold - PPO
  • Blue Cross� Premier PPO Gold Extra - PPO
  • Blue Cross� Premier PPO Silver - PPO
  • Blue Cross� Premier PPO Silver Extra - PPO
  • Blue Cross� Premier PPO Silver Saver HSA - PPO
  • Blue Cross� Premier PPO Value - PPO

Blue Cross Blue Shield of Wyoming

  • BlueSelect Bronze Basic - PPO
  • BlueSelect Bronze Core - PPO
  • BlueSelect Expanded Bronze Standard without Kid's Dental - PPO
  • BlueSelect Gold Core - PPO
  • BlueSelect Gold HealthPlus - PPO
  • BlueSelect Gold Standard without Kid's Dental - PPO
  • BlueSelect Silver Classic - PPO
  • BlueSelect Silver Classic without Kid's Dental - PPO
  • BlueSelect Silver HealthPlus - PPO
  • BlueSelect Silver HealthPlus without Kid's Dental - PPO
  • BlueSelect Silver Standard without Kid's Dental - PPO

HAP CareSource

  • Bronze First - HMO
  • Bronze First Adult Vision & Fitness - HMO
  • Diabetes Gold - HMO
  • Diabetes Gold Adult Vision & Fitness - HMO
  • Diabetes Silver - HMO
  • Diabetes Silver Adult Vision & Fitness - HMO
  • Gold - HMO
  • Gold Adult Vision & Fitness - HMO
  • HDHP Preventive Silver - HMO
  • Healthy Heart Gold - HMO
  • Healthy Heart Gold Adult Vision & Fitness - HMO
  • Healthy Heart Silver - HMO
  • Healthy Heart Silver Adult Vision & Fitness - HMO
  • Low Premium Silver - HMO
  • Low Premium Silver Adult Vision & Fitness - HMO
  • Silver - HMO
  • Silver Adult Vision & Fitness - HMO

McLaren Health Plan Community

  • MHP Bronze - HMO
  • MHP Bronze Saver (Expanded) - HMO
  • MHP Expanded Bronze Standard - HMO
  • MHP Gold - HMO
  • MHP Gold Standard - HMO
  • MHP Silver Exchange - HMO
  • MHP Silver Exchange Rewards - HMO
  • MHP Silver Standard - HMO
  • MHP Young Adult/Catastrophic - HMO

Oscar Insurance Company

  • Bronze Classic 4700 - EPO
  • Bronze Classic Standard - EPO
  • Bronze Elite + PCP Saver Plus - EPO
  • Gold Classic Standard - EPO
  • Gold Elite Saver Plus - EPO
  • Secure - EPO
  • Silver Classic - EPO
  • Silver Classic Standard - EPO
  • Silver Simple PCP Saver - EPO

Priority Health

  • MyPriority Balanced Silver - HMO
  • MyPriority Premier Silver - HMO
  • MyPriority Standard Bronze - HMO
  • MyPriority Standard Bronze - Travel - HMO
  • MyPriority Standard Gold - HMO
  • MyPriority Standard Silver - HMO
  • MyPriority Standard Silver - Travel - HMO
  • MyPriority Value Bronze - HMO
  • MyPriority Value Bronze HSA - HMO

UnitedHealthcare

  • UHC Bronze Copay Focus (No Referrals) - HMO
  • UHC Bronze Standard (No Referrals) - HMO
  • UHC Bronze Value (No Referrals) - HMO
  • UHC Bronze Value+ (Dental + Vision, No Referrals) - HMO
  • UHC Gold Advantage (No Referrals) - HMO
  • UHC Gold Advantage+ (Dental + Vision, No Referrals) - HMO
  • UHC Gold Copay Focus (No Referrals) - HMO
  • UHC Gold Standard (No Referrals) - HMO
  • UHC Silver Advantage (No Referrals) - HMO
  • UHC Silver Advantage+ (Dental + Vision, No Referrals) - HMO
  • UHC Silver Standard (No Referrals) - HMO
  • UHC Silver Value (No Referrals) - HMO
  • UHC Silver Value+ (Dental + Vision, No Referrals) - HMO

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Blue Cross Blue Shield

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
H42351OTHER (01)MIHAP
4606945MEDICAID (05)MI 
N32640001MEDICARE PIN (08)MI 
0501160OTHER (01)MIBLUE CARE NETWORK - BCBS
140631OTHER (01)MIGREAT LAKES
0N32640MEDICARE PIN (08)MI 

Medicare Participation & PECOS Enrollment Status

Shabbir Khambati 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.

Shabbir Khambati 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: 7719881937

    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: I20031120000430

    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.

Cataract surgery

Cataract surgery is a procedure to remove the lens of your eye when it becomes cloudy, which is called a cataract. A synthetic lens is then inserted to restore clear vision. The operation is typically done on an outpatient basis and is very safe and effective.

This service was performed for 15 patients

Established patient complete exam of visual system

An established patient complete exam of the visual system involves a thorough check of your eyes and vision. It assesses eye health, checks for diseases, and measures your ability to see clearly at different distances. It's a routine, non-invasive procedure.

This service was performed 75 times for 63 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 39 times for 29 patients

Established patient problem focused exam of visual system

This is a routine check-up for existing patients focusing on the visual system. It involves examining your eyes to detect any potential issues or changes in your vision. It's a crucial part of maintaining good eye health.

This service was performed 128 times for 94 patients

Evaluation of eye adaptation to light and dark

This procedure checks how your eyes adjust to different light conditions. In a dimly lit room, your eyes are first exposed to bright light. Then, the lights are turned off to see how quickly your eyes adapt to darkness. This helps identify any potential vision problems.

This service was performed 56 times for 56 patients

Exam of the internal drainage system of eye

This is a procedure where your doctor examines the eye's internal drainage system, essential for maintaining eye pressure. They use specialized tools to check for blockages or damage that might lead to conditions like glaucoma. It's non-invasive and painless.

This service was performed 34 times for 30 patients

Exam of visual field with extended testing

An extended visual field exam is a detailed test to evaluate your peripheral (side) vision. It helps to detect any potential blind spots which may not be noticeable in daily life. These could be caused by eye diseases like glaucoma, or neurological conditions.

This service was performed 184 times for 124 patients

Extended exam involving color vision testing

An extended exam involving color vision testing helps identify any difficulties in distinguishing colors, often due to genetic conditions or health problems. This non-invasive test involves identifying different colored numbers or patterns.

This service was performed 133 times for 97 patients

Extended exam of the back part of the eye with optic nerve drawing

This procedure involves a detailed examination of the back part of your eye, focusing on the optic nerve, a crucial component for vision. A drawing or map of the optic nerve is created to help track any changes over time. This can help detect eye diseases early.

This service was performed 25 times for 23 patients

Extended exam of the back part of the eye with retinal drawing

This procedure involves a detailed examination of the back part of your eye, including the retina. It helps identify any abnormalities or issues. A retinal drawing is made to record findings. It's non-invasive and crucial for maintaining eye health.

This service was performed 42 times for 41 patients

Imaging of optic nerve

Imaging of the optic nerve is a non-invasive procedure that captures detailed pictures of your optic nerve. It helps doctors assess eye health, particularly for conditions like glaucoma. It's painless, quick, and uses safe technology like MRI or OCT (Optical Coherence Tomography).

This service was performed 93 times for 83 patients

Imaging of retina

Imaging of the retina is a non-invasive procedure that captures detailed images of your eye's interior. This helps detect conditions like macular degeneration or retinal detachment. It's painless and takes only a few minutes.

This service was performed 53 times for 47 patients

Measurement of nerve conduction using visual stimulation testing with report

This procedure involves testing the speed and strength of signals traveling through your nerves, using visual stimuli. It helps identify any nerve damage or dysfunction. A report of the results is provided for further analysis.

This service was performed 169 times for 115 patients

Measurement of retinal and optic nerve function

This procedure checks the health of your eyes, specifically the retina and optic nerve. These parts help in visual interpretation. The test involves non-invasive techniques to measure your eye's response to light and assess its functioning.

This service was performed 217 times for 145 patients

Measurement of retinal and optic nerve function targeting multiple separate locations

This procedure measures the health of your eye's retina and optic nerve. It focuses on various specific areas to identify potential issues. The test is non-invasive, painless, and helps detect eye conditions early for effective treatment.

This service was performed 106 times for 76 patients

Microfluid analysis of tears

Microfluid analysis of tears involves collecting a small tear sample to examine its composition. This procedure can help detect health issues like dry eye disease, inflammation, or other eye conditions. It's a non-invasive, painless method for monitoring eye health.

This service was performed 262 times for 78 patients

New patient complete exam of visual system

A new patient complete exam of the visual system is a thorough evaluation of your eyes and vision. It checks for any potential issues and assesses overall eye health. It includes tests for visual acuity, eye movement, and light response.

This service was performed 42 times for 42 patients

Pattern recording of retinal electrical responses to external stimuli with interpretation and report

This procedure records the electrical responses of your retina to light stimuli. It helps understand how your eye cells are functioning. A report is prepared interpreting the results, aiding in diagnosis and treatment planning.

This service was performed 173 times for 114 patients

Photography of content of eyes

Photography of the content of eyes, also known as ocular photography, captures detailed images of different parts of the eye. It helps identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. The process is non-invasive and painless.

This service was performed 196 times for 112 patients

Photography of the retina

Photography of the retina, also known as retinal imaging, is a non-invasive procedure that captures images of the back of your eye. This helps doctors identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. It's painless and quick, often part of a routine eye exam.

This service was performed 125 times for 111 patients

Placement of amniotic membrane on eye surface for wound healing

The placement of an amniotic membrane on the eye surface is a treatment to promote healing of eye wounds. It involves placing a thin, protective layer over the eye. This layer, derived from the amniotic membrane, helps reduce inflammation and scarring, while encouraging healing.

This service was performed 34 times for 18 patients

Removal of excessive skin and fat of upper eyelid

This procedure, also known as upper eyelid surgery, is performed to remove excess skin and fat from the upper eyelid. It can help improve vision if heavy eyelids hinder it, and can also enhance the appearance of the eyes. It's a common, safe procedure.

This service was performed 12 times for 12 patients

Repair of tendon of upper eyelid

Repair of the tendon of the upper eyelid is a surgical procedure aimed at fixing a droopy eyelid. This condition can affect your vision and appearance. The procedure involves tightening the tendon to lift the eyelid to its normal position, improving both function and aesthetics.

This service was performed 12 times for 12 patients

Physician Visit Costs



The typical physician office visit costs for Medicare beneficiaries in this area are: $33.57 for a new patient copayment and $18.09 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 48035 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99204

  • Average New Patient Price $134.28
  • Minimum New Patient Price $58.04
  • Maximum New Patient Price $177.36
  • Average New Patient Copayment $33.57
  • Minimum New Patient Copayment $14.51
  • Maximum New Patient Copayment $44.34

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

  • Average Established Patient Price $72.38
  • Minimum Established Patient Price $18.32
  • Maximum Established Patient Price $143.49
  • Average Established Patient Copayment $18.09
  • Minimum Established Patient Copayment $4.58
  • Maximum Established Patient Copayment $35.87

* 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 93.01, 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: 93.01 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: 86.02

    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: 40

    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.

Quality Measure Performance Number of Patients
Diabetes: Eye Exam 100% 90
Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care 100% 98
Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months
e-Prescribing 100% 119
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Patient-Specific Education 98% 677
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: Tobacco Use: Screening and Cessation Intervention 100% 25
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
Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation 100% 114
Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits within 12 months
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 0% 677
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.
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.

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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.
1104938257
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
210418316210
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 1 + 0 + 4 + 1 + 8 + 3 + 1 + 6 + 2 + 1 + 0 + 24 = 53
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 53 = 77

The NPI number 1104938257 is valid because the calculated check digit 7 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1083836829PAIN & WELLNESS CENTER, L.L.C
Organization		Chiropractor35426 HARPER AVE
CLINTON TWP, MI 48035
(586) 790-7400

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1104938257, enumerated in the NPI registry as an "individual" on August 31, 2006

The provider is located at 35426 Harper Ave Clinton Twp, Mi 48035 and the phone number is (586) 792-3891

The provider's speciality is Ophthalmology with taxonomy code 207W00000X

The provider has more than 29 years of experience. He graduated from Wayne State University School Of Medicine in 1997.

The provider might be accepting Accepts: Ambetter from Meridian, Ambetter Health, Blue Care. 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.

The provider has an overall high rating in the following quality measures: quality clinical practices and patient outcomes and experiences.

Medicare beneficiaries should expect a typical cost of $134.28 with an average copayment of $33.57 for new patient appointments. Established patients should expect a typical charge of $72.38 and an average copayment of 18.09. 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: Cataract surgery, Established patient complete exam of visual system, Established patient office or other outpatient visit, 20-29 minutes, Established patient problem focused exam of visual system, Evaluation of eye adaptation to light and dark, Exam of the internal drainage system of eye, Exam of visual field with extended testing, Extended exam involving color vision testing, Extended exam of the back part of the eye with optic nerve drawing, Extended exam of the back part of the eye with retinal drawing, Imaging of optic nerve, Imaging of retina, Measurement of nerve conduction using visual stimulation testing with report, Measurement of retinal and optic nerve function, Measurement of retinal and optic nerve function targeting multiple separate locations, Microfluid analysis of tears, New patient complete exam of visual system, Pattern recording of retinal electrical responses to external stimuli with interpretation and report, Photography of content of eyes, Photography of the retina, Placement of amniotic membrane on eye surface for wound healing, Removal of excessive skin and fat of upper eyelid and Repair of tendon of upper eyelid.

This NPI record was last updated on August 31, 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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