DR. CRAIG M BUETTNER MD
NPI 1134291263
Family Medicine in Tuscaloosa, AL
Quality Rating: 85.47 out of 100 score
NPI Status: Active since November 14, 2006
Contact Information
100 RICE MINE ROAD LOOP
SUITE 206
TUSCALOOSA, AL
ZIP 35406
Phone: (205) 339-0171
Fax: (205) 333-8681
- Individual
- Male
- Years of Experience 35
- Family Medicine
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
- Medicare Quality Reporting
About CRAIG BUETTNER
This page provides the complete NPI Profile along with additional information for Craig Buettner, a primary care provider established in Tuscaloosa, Alabama with a medical specialization in Family Medicine and more than 35 years of experience. He graduated from Louisiana State University School Of Medicine In Shreveport in 1991. The healthcare provider is registered in the NPI registry with number 1134291263 assigned on November 2006. The practitioner's primary taxonomy code is 207Q00000X with license number 00016599 (AL). The provider is registered as an individual and his NPI record was last updated 17 years ago.
- NPI
- 1134291263
- Provider Name
- DR. CRAIG M BUETTNER MD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 100 RICE MINE ROAD LOOP SUITE 206 TUSCALOOSA, AL 35406
- Location Phone
- (205) 339-0171
- Location Fax
- (205) 333-8681
- Mailing Address
- 100 RICE MINE ROAD LOOP SUITE 206 TUSCALOOSA, AL 35406
- Mailing Phone
- (205) 339-0171
- Mailing Fax
- (205) 333-8681
- Medical School Name
- LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT
- Graduation Year
- 1991
- Is Sole Proprietor?
- No
- Enumeration Date
- 11-14-2006
- Last Update Date
- 02-20-2008
- Code Navigator
A primary care provider (PCP) like Craig Buettner sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc
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
Family Medicine
- Taxonomy Code
- 207Q00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 00016599
- License State
- AL
- Taxonomy Description
- Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Cross Select Gold - PPO
- Blue Cross Select Silver - PPO
- Blue HSA Bronze - PPO
- Blue Protect - PPO
- Blue Saver Bronze - PPO
- Blue Standardized Bronze - PPO
- Blue Standardized Gold - PPO
- Blue Standardized Silver - PPO
- Blue Value Gold - PPO
- Blue Value Silver - PPO
- Blue Access Gold for Business - PPO
- Blue Choice Platinum for Business - PPO
- Blue HSA Silver for Business - PPO
- Blue Saver Bronze for Business - PPO
- Blue Saver Gold for Business - PPO
- Blue Secure Gold for Business - PPO
- Blue Secure Silver for Business - PPO
- UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - EPO
- UHC Bronze Standard (No Referrals) - EPO
- UHC Bronze Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, No Referrals) - EPO
- UHC Bronze Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, Dental + Vision, No Referrals) - EPO
- UHC Gold Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - EPO
- UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) - EPO
- UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - EPO
- UHC Gold Standard (No Referrals) - EPO
- UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - EPO
- UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) - EPO
- UHC Silver Standard (No Referrals) - EPO
- UHC Silver Value ($0 Virtual Urgent Care, $2 Tier 2 Rx, No Referrals) - EPO
- UHC Silver Value+ ($0 Virtual Urgent Care, $2 Tier 2 Rx, Dental + Vision, No Referrals) - EPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
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 |
---|---|---|---|
F29539 | MEDICARE UPIN (02) | AL | |
1104250001 | MEDICARE NSC (07) | AL |
Medicare Participation & PECOS Enrollment Status
Craig Buettner 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.
Craig Buettner 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: 648229062
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: I20050112000916
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.
Durable Medical Equipment
DME-Other DME (DE017N)
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (HCPCS:A4253)
14 DME suppliers used 29 Medicare Claims 95 Services Paid
DME-Medical/Surgical Supplies (DA000N)
Lancets, per box of 100 (HCPCS:A4259)
7 DME suppliers used 16 Medicare Claims 24 Services Paid
DME-Hospital Beds (DB000N)
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress (HCPCS:E0261)
1 DME suppliers used 11 Medicare Claims 11 Services Paid
DME-Wheelchairs (DD000N)
Standard wheelchair (HCPCS:K0001)
3 DME suppliers used 13 Medicare Claims 13 Services Paid
DME-Other DME (DE017N)
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service (HCPCS:K0553)
4 DME suppliers used 31 Medicare Claims 31 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.
Administration of influenza virus vaccine
Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle
Administration of pneumococcal vaccine
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
Aspiration and/or injection of fluid large joint using ultrasound guidance
Automated urinalysis test
Blood test, lipids (cholesterol and triglycerides)
Creatinine level to test for kidney function or muscle injury
Detection test by immunoassay with direct visual observation for influenza virus
Dxa bone density measurement of hip, pelvis, spine
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
Established patient office or other outpatient visit, 40-54 minutes
Hemoglobin a1c level, by device for home use
Influenza vaccine split virus, preservative free
Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
Injection of drug or substance under skin or into muscle
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg
Injection, ceftriaxone sodium, per 250 mg
Injection, denosumab, 1 mg
Injection, dexamethasone sodium phosphate, 1 mg
Injection, triamcinolone acetonide, not otherwise specified, 10 mg
Insertion of needle into vein for collection of blood sample
Limited ultrasound scan of abdomen
Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report
Stool analysis for blood, by fecal hemoglobin determination by immunoassay
Test to measure expiratory airflow and volume
Ultrasound scan of head and neck soft tissue
Ultrasound study of arm or leg veins with compression and maneuvers
Urine microalbumin (protein) analysis
X-ray of abdomen, 2 views
X-ray of chest, 2 views
X-ray of foot, minimum of 3 views
X-ray of hip, 2-3 views
X-ray of knee, 4 or more views
X-ray of lower and sacral spine, minimum of 4 views
X-ray of paranasal sinus, 1-2 views
X-ray of shoulder, minimum of 2 views
X-ray of upper spine, 4-5 views
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
This service was performed 103 times for 100 patientsThis procedure involves giving anti-cancer drugs, which don't contain hormones, into the muscle or under the skin. These drugs help to stop the growth of cancer cells. The process is usually quick and done by a healthcare professional.
This service was performed 44 times for 26 patientsThe pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.
This service was performed 26 times for 26 patientsAn annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
This service was performed 281 times for 281 patientsThis procedure involves using ultrasound technology to accurately locate a large joint, usually the knee or shoulder. A needle is then inserted to either extract fluid (aspiration) or inject medication. The ultrasound helps ensure precision and safety.
This service was performed 33 times for 14 patientsAn automated urinalysis test is a routine examination that checks your urine for various substances. It can help identify potential health issues such as kidney problems or diabetes. The test uses a machine to analyze a small urine sample, providing quick and accurate results.
This service was performed 253 times for 208 patientsA lipid panel is a blood test that measures fats and fatty substances, such as cholesterol and triglycerides. These substances are used by your body as a source of energy. High levels can lead to health issues, including heart disease.
This service was performed 209 times for 168 patientsA creatinine level test measures the amount of creatinine in your blood. This substance is a waste product from normal muscle use. Higher levels can indicate possible kidney dysfunction or muscle injury. This test helps monitor kidney health.
This service was performed 66 times for 63 patientsThis is a test that identifies the influenza virus in your body. It works by using an immunoassay, a method that detects the presence of the virus through an immune response. The results are directly observable, making it a quick and efficient way to diagnose flu.
This service was performed 16 times for 16 patientsA DXA bone density measurement is a simple, quick, and non-invasive procedure that assesses the strength of your bones. This test uses X-rays to measure the amount of minerals, mainly calcium, in the hip, pelvis, and spine. It helps in early detection of osteoporosis or other bone diseases.
This service was performed 27 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 22 times for 20 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 158 times for 114 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 519 times for 279 patientsThis service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
This service was performed 342 times for 211 patientsA Hemoglobin A1c device for home use allows you to check your average blood sugar levels over the past 3 months. It's a simple, painless test that provides immediate results, helping you manage your diabetes more effectively.
This service was performed 56 times for 48 patientsThe Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
This service was performed 97 times for 95 patientsAn Initial Preventive Physical Examination, also known as a "Welcome to Medicare" visit, is a one-time, face-to-face visit during your first 12 months of Medicare enrollment. It includes a review of your health, as well as education and counseling about preventive services and further screenings.
This service was performed 14 times for 14 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 232 times for 80 patientsThis injection contains two medications, betamethasone acetate and betamethasone sodium phosphate. It is used to reduce inflammation and pain. It's given by a healthcare professional, often directly into the area causing discomfort.
This service was performed 12 times for 11 patientsCeftriaxone sodium is an antibiotic injection used to treat a variety of bacterial infections. Each injection contains 250 mg of the medicine. It works by stopping the growth of bacteria in your body.
This service was performed 243 times for 50 patientsDenosumab is a medication given via injection to strengthen your bones. It works by slowing down the cells that break down bone, improving bone density and reducing the risk of fractures. It's often used for osteoporosis treatment.
This service was performed 2,640 times for 26 patientsDexamethasone sodium phosphate is a medication given via injection. It is a type of steroid that helps reduce inflammation and immune responses. It can be used to treat a variety of conditions, such as allergies, skin conditions, arthritis, and more.
This service was performed 367 times for 41 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 141 times for 21 patientsThis procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
This service was performed 824 times for 371 patientsA limited ultrasound scan of the abdomen is a non-invasive imaging test. It uses sound waves to produce images of the abdominal organs such as the liver, gallbladder, spleen, pancreas, and kidneys. This helps to identify any abnormalities or issues.
This service was performed 11 times for 11 patientsThe Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.
This service was performed 17 times for 17 patientsAn electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.
This service was performed 45 times for 40 patientsA stool analysis for blood, or fecal hemoglobin determination by immunoassay, is a test that checks for hidden blood in your stool. This test helps identify potential issues in your digestive system. It involves collecting a small stool sample which is then analyzed in a lab for the presence of blood.
This service was performed 211 times for 208 patientsThis test, known as spirometry, assesses how well your lungs work. It measures how much air you can inhale, how much you can exhale and how quickly you can exhale. It's non-invasive and helps diagnose conditions like asthma or COPD.
This service was performed 24 times for 19 patientsAn ultrasound scan of the head and neck soft tissue is a non-invasive procedure that uses sound waves to create images of the soft tissues in these areas. It helps identify any abnormalities or issues, such as tumors, cysts, or infections. It's painless and doesn't involve radiation.
This service was performed 13 times for 11 patientsAn ultrasound study of arm or leg veins with compression and maneuvers is a non-invasive procedure that uses sound waves to create images of your veins. This helps identify blood clots or other vein problems. During the procedure, pressure is applied to the veins and certain movements are performed to assess blood flow.
This service was performed 16 times for 15 patientsUrine microalbumin analysis is a test that measures the amount of a protein called albumin in your urine. This protein is usually present in very small amounts, but higher levels can indicate kidney issues. The test is non-invasive and involves a simple urine sample.
This service was performed 67 times for 64 patientsAn X-ray of the abdomen, 2 views, is a non-invasive imaging test. It uses a small amount of radiation to capture pictures of the structures inside your belly. The two views provide different angles, helping doctors see your organs clearly and detect any issues.
This service was performed 26 times for 23 patientsA chest X-ray, 2 views, is a quick, painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. Two different angles are used to get a comprehensive view. This helps in diagnosing conditions like pneumonia, heart problems, or lung cancer.
This service was performed 98 times for 71 patientsAn X-ray of the foot, minimum of 3 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of the bones and tissues in your foot. This helps to identify fractures, infections, or other abnormalities. Multiple views ensure a comprehensive examination.
This service was performed 28 times for 17 patientsAn X-ray of the hip with 2-3 views is a non-invasive imaging test. It uses a small amount of radiation to produce pictures of the hip joint. These images help in diagnosing conditions like fractures, arthritis, or other abnormalities. The process is quick and painless.
This service was performed 24 times for 18 patientsAn X-ray of the knee, 4 or more views, is a non-invasive imaging test. It involves capturing multiple images of your knee from different angles. This helps in diagnosing conditions such as fractures, arthritis, or infections. The procedure is quick and painless.
This service was performed 32 times for 24 patientsAn X-ray of the lower and sacral spine involves capturing images of your lower back and tailbone area. It helps in identifying issues like fractures, arthritis, or other abnormalities. At least four different angles or 'views' are taken to get a comprehensive picture.
This service was performed 25 times for 21 patientsAn X-ray of the paranasal sinus is a safe, quick imaging procedure. It uses a small amount of radiation to create images of the sinus cavities in your face. This helps doctors diagnose conditions such as sinusitis or other sinus problems. The 1-2 views mean images from one or two different angles will be taken.
This service was performed 60 times for 47 patientsAn X-ray of the shoulder, with a minimum of 2 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of your shoulder bones. This helps in diagnosing conditions like fractures, arthritis, or other abnormalities. The procedure is quick and painless.
This service was performed 20 times for 18 patientsAn X-ray of the upper spine with 4-5 views is a non-invasive imaging test. It uses radiation to capture detailed images of the bones and structures in your neck and upper back. This procedure helps identify issues like fractures, infections, or deformities.
This service was performed 12 times for 11 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $20.47 for a new patient copayment and $23.43 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 35406 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $81.9
- Minimum New Patient Price $52.65
- Maximum New Patient Price $161.63
- Average New Patient Copayment $20.47
- Minimum New Patient Copayment $13.16
- Maximum New Patient Copayment $40.4
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $93.72
- Minimum Established Patient Price $16.56
- Maximum Established Patient Price $131.65
- Average Established Patient Copayment $23.43
- Minimum Established Patient Copayment $4.14
- Maximum Established Patient Copayment $32.91
* 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 85.47, 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 provider also has detailed performance information the following quality measures: .
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.
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Final Score: 85.47 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.
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Quality Score: 100
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.
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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: 51.58
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: 51.58
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 Quality Measures
The following performance measures were reported under the Merit-Based Incentive Payment System (MIPS) and Qualified Clinical Data Registry (QCDR) quality measures program.
Quality Measure | Performance | Number of Patients |
---|---|---|
Appropriate Testing for Pharyngitis | 0% | 108 |
Appropriate Treatment for Upper Respiratory Infection (URI) | 37% | 103 |
Breast Cancer Screening | 0% | 731 |
Cervical Cancer Screening | 0% | 975 |
Diabetes: Eye Exam | 0% | 417 |
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) | 22% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better. | 417 |
Diabetes: Medical Attention for Nephropathy | 90% | 417 |
Falls: Screening for Future Fall Risk | 0% | 929 |
Pneumococcal Vaccination Status for Older Adults | 58% | 874 |
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | 27% | 3198 |
Preventive Care and Screening: Influenza Immunization | 10% | 2474 |
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | 0% | 2414 |
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | 0% | 2414 |
Use of High-Risk Medications in Older Adults | 2% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better. | 929 |
Use of High-Risk Medications in Older Adults | 5% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better. | 929 |
Use of High-Risk Medications in Older Adults | 4% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better. | 929 |
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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 | 1 | 3 | 4 | 2 | 9 | 1 | 2 | 6 | 3 |
Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
2 | 1 | 6 | 4 | 4 | 9 | 2 | 2 | 12 | |
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
2 + 1 + 6 + 4 + 4 + 9 + 2 + 2 + 1 + 2 + 24 = 57 | |||||||||
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
60 - 57 = 3 | 3 |
The NPI number 1134291263 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 15 providers are registered at the same or nearby location.
NPI | Name / Type | Taxonomy | Address |
---|---|---|---|
1366407199 | FOWLER SPORTS MEDICINE & ORTHOPAEDICS Organization | Orthopaedic Surgery | 100 RICE MINE ROAD LOOP SUITE 205 TUSCALOOSA, AL 35406 (205) 752-1800 |
1962467290 | MR. MICHAEL JEFFERY DELLAPENNA PA Individual | Physician Assistant | 100 RICE MINE ROAD LOOP SUITE 205 TUSCALOOSA, AL 35406 (205) 752-1800 |
1144285453 | DR. HOWARD LESLIE FOWLER M.D. Individual | Orthopaedic Surgery | 100 RICE MINE ROAD LOOP SUITE 205 TUSCALOOSA, AL 35406 (205) 752-1800 |
1184796211 | DR. JEFFERY C LAUBENTHAL MD Individual | Family Medicine | 100 RICE MINE ROAD LOOP SUITE 206 TUSCALOOSA, AL 35406 (205) 339-0171 |
1922176536 | MS. BARBARA C CLEINO CRNP Individual | Nurse Practitioner (Family) | 100 RICE MINE ROAD LOOP SUITE 206 TUSCALOOSA, AL 35406 (205) 339-0171 |
1336207372 | MR. LACEY C QUARLES CRNP Individual | Nurse Practitioner (Family) | 100 RICE MINE ROAD LOOP SUITE 206 TUSCALOOSA, AL 35406 (205) 339-0171 |
1366501223 | FOWLER SPORTS MEDICINE & ORTHOPAEDICS II Organization | Orthopaedic Surgery | 100 RICE MINE ROAD LOOP SUITE 205 TUSCALOOSA, AL 35406 (205) 752-1800 |
1124169552 | MR. VIRAL PATEL DPT Individual | Physical Therapist | 100 RICE MINE ROAD LOOP SUITE 102 TUSCALOOSA, AL 35406 (205) 342-2610 |
1881809432 | MET-TEST, LLC Organization | Respiratory Therapist, Certified (Pulmonary Function Technologist) | 100 RICE MINE ROAD LOOP SUITE 206 TUSCALOOSA, AL 35406 (678) 636-3060 |
1659571784 | BLACK WARRIOR SERVICES, LLC Organization | Specialist | 100 RICE MINE ROAD LOOP TUSCALOOSA, AL 35406 (205) 469-4104 |
1235445024 | SOUTHERN DIAGNOSTIC LABORATORIES, LLC Organization | Clinical Medical Laboratory | 100 RICE MINE ROAD LOOP SUITE 100 TUSCALOOSA, AL 35406 (205) 248-9894 |
1790057420 | BAMA HEART DOC, P.C. Organization | Internal Medicine (Interventional Cardiology) | 100 RICE MINE ROAD LOOP SUITE 104 TUSCALOOSA, AL 35406 (205) 342-2552 |
1285084970 | MOLLY BROWDER PTH Individual | Physical Therapist | 100 RICE MINE ROAD LOOP SUITE 102 TUSCALOOSA, AL 35406 (205) 342-2610 |
1679845531 | MRS. DANA LYNN HEMSTREET CRNP Individual | Nurse Practitioner (Family) | 100 RICE MINE ROAD LOOP SUITE 104 TUSCALOOSA, AL 35406 (205) 342-2552 |
1376615476 | WEST ALABAMA FAMILY PRACTICE & SPORTS MEDICINE PC Organization | Family Medicine | 100 RICE MINE ROAD LOOP SUITE 206 TUSCALOOSA, AL 35406 (205) 339-0171 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1134291263, enumerated in the NPI registry as an "individual" on November 14, 2006
The provider is located at 100 Rice Mine Road Loop Suite 206 Tuscaloosa, Al 35406 and the phone number is (205) 339-0171
The provider's speciality is Family Medicine with taxonomy code 207Q00000X
The provider has more than 35 years of experience. He graduated from Louisiana State University School Of Medicine In Shreveport in 1991.
The provider might be accepting Accepts: Blue Cross and Blue Shield of Alabama,. 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. The provider obtained a high score in the following performance measures: Diabetes: Medical Attention for Nephropathy , Use of High-Risk Medications in Older Adults. The quality ratings are based on unbiased reviews and reported submissions to Medicare's Quality Payment Program.
Medicare beneficiaries should expect a typical cost of $81.9 with an average copayment of $20.47 for new patient appointments. Established patients should expect a typical charge of $93.72 and an average copayment of 23.43. 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: Administration of influenza virus vaccine, Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle, Administration of pneumococcal vaccine, Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit, Aspiration and/or injection of fluid large joint using ultrasound guidance, Automated urinalysis test, Blood test, lipids (cholesterol and triglycerides), Creatinine level to test for kidney function or muscle injury, Detection test by immunoassay with direct visual observation for influenza virus, Dxa bone density measurement of hip, pelvis, spine, 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, Established patient office or other outpatient visit, 40-54 minutes, Hemoglobin a1c level, by device for home use, Influenza vaccine split virus, preservative free, Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment, Injection of drug or substance under skin or into muscle, Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg, Injection, ceftriaxone sodium, per 250 mg, Injection, denosumab, 1 mg, Injection, dexamethasone sodium phosphate, 1 mg, Injection, triamcinolone acetonide, not otherwise specified, 10 mg, Insertion of needle into vein for collection of blood sample, Limited ultrasound scan of abdomen, Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use, Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report, Stool analysis for blood, by fecal hemoglobin determination by immunoassay, Test to measure expiratory airflow and volume, Ultrasound scan of head and neck soft tissue, Ultrasound study of arm or leg veins with compression and maneuvers, Urine microalbumin (protein) analysis, X-ray of abdomen, 2 views, X-ray of chest, 2 views, X-ray of foot, minimum of 3 views, X-ray of hip, 2-3 views, X-ray of knee, 4 or more views, X-ray of lower and sacral spine, minimum of 4 views, X-ray of paranasal sinus, 1-2 views, X-ray of shoulder, minimum of 2 views and X-ray of upper spine, 4-5 views.
This NPI record was last updated on November 14, 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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