MICHAEL LYNN WHITLOW MD
NPI 1174521132
Specialist in Augusta, GA
Quality Rating: 58.55 out of 100 score
NPI Status: Active since July 13, 2005
Contact Information
1109 MEDICAL CENTER DR
BUILDING #5
AUGUSTA, GA
ZIP 30909
Phone: (706) 863-6637
Fax: (706) 863-6638
- Individual
- Male
- Years of Experience 51
- Specialist
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
- Medicare Quality Reporting
About MICHAEL WHITLOW
This page provides the complete NPI Profile along with additional information for Michael Whitlow, a provider established in Augusta, Georgia with a medical specialization in Specialist and more than 51 years of experience. He graduated from Medical College Of Georgia School Of Medicine in 1975. The healthcare provider is registered in the NPI registry with number 1174521132 assigned on July 2005. The practitioner's primary taxonomy code is 174400000X with license number 018345 (GA). The provider is registered as an individual and his NPI record was last updated 18 years ago.
- NPI
- 1174521132
- Provider Name
- MICHAEL LYNN WHITLOW MD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 1109 MEDICAL CENTER DR BUILDING #5 AUGUSTA, GA 30909
- Location Phone
- (706) 863-6637
- Location Fax
- (706) 863-6638
- Mailing Address
- 1109 MEDICAL CENTER DR BUILDING #5 AUGUSTA, GA 30909
- Mailing Phone
- (706) 863-6637
- Mailing Fax
- (706) 863-6638
- Medical School Name
- MEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE
- Graduation Year
- 1975
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 07-13-2005
- Last Update Date
- 07-09-2007
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Specialist
- Taxonomy Code
- 174400000X
- Type
- Other Service Providers
- License No.
- 018345
- License State
- GA
- Taxonomy Description
- An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- SoloCare Bronze EPO HDHP 8050 10004 - EPO
- SoloCare Exp Bronze EPO 7200 - $0 Generic Rx 10015 - EPO
- SoloCare Gold EPO 2300 - 3 Free PCP Visits, $5 Generic Rx 10010 - EPO
- SoloCare Silver EPO 6000/60 - 3 Free PCP Visits 10014 - EPO
- SoloCare Silver EPO 7000 - 3 Free PCP Visits, $5 Generic Rx 10013 - EPO
- SoloCare Standard Exp Bronze EPO 10008 - EPO
- SoloCare Standard Gold EPO 10006 - EPO
- SoloCare Standard Platinum EPO 10005 - EPO
- SoloCare Standard Silver EPO 10007 - EPO
- Blue Direction Silver 1 - POS
- Blue Direction Silver 1 + Adult Vision - POS
- Blue Direction Silver 2 - POS
- Blue Direction Standard Gold - POS
- Blue Direction Standard Silver - POS
- Blue VirtuConnect Bronze 1 - EPO
- Blue VirtuConnect Gold 1 - EPO
- Blue VirtuConnect Silver 1 - EPO
- BlueEssentials Bronze 4 - EPO
- BlueEssentials Bronze 6 - EPO
- BlueEssentials Catastrophic 1 - EPO
- BlueEssentials Gold 1 - EPO
- BlueEssentials Gold 5 - EPO
- BlueEssentials Silver 14 - EPO
- BlueEssentials Silver 14 + Adult Vision - EPO
- BlueEssentials Silver 39 - EPO
- BlueEssentials Standard Expanded Bronze - EPO
- BlueEssentials Standard Gold - EPO
- BlueEssentials Standard Silver - EPO
- BlueExtend PPO HD Bronze 1 - PPO
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 |
|---|---|---|---|
| D41375 | MEDICARE UPIN (02) | GA |
Medicare Participation & PECOS Enrollment Status
Michael Whitlow 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.
Michael Whitlow 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: 7517937840
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: I20040727000796
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.
Dialysis services, per day, less than full month service (20 years or older)
Established patient office or other outpatient visit, 30-39 minutes
Follow-up hospital inpatient care per day, typically 15 minutes
Follow-up hospital inpatient care per day, typically 25 minutes
Initial hospital inpatient care per day, typically 50 minutes
Dialysis is a treatment that replicates some functions of healthy kidneys when they're not working properly. It helps to remove waste, salt, and excess water from your body and maintain a safe level of certain chemicals in your blood. This service, for patients aged 20 or older, is provided on a daily basis for less than a full month.
This service was performed 164 times for 18 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 272 times for 139 patientsFollow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.
This service was performed 25 times for 13 patientsFollow-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 71 times for 23 patientsInitial 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 15 times for 11 patientsOverall 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 58.55, 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.
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Final Score: 58.55 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: 84.96
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: 0
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: 65.21
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: 65.21
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 |
|---|---|---|
| Advance Care Planning | Yes | N/A |
| Implementation of practices/processes to develop advance care planning that includes: documenting the advance care plan or living will within the medical record, educating clinicians about advance care planning motivating them to address advance care planning needs of their patients, and how these needs can translate into quality improvement, educating clinicians on approaches and barriers to talking to patients about end-of-life and palliative care needs and ways to manage its documentation, as well as informing clinicians of the healthcare policy side of advance care planning. | ||
| Annual registration in the Prescription Drug Monitoring Program | Yes | N/A |
| Annual registration by eligible clinician or group in the prescription drug monitoring program of the state where they practice. Activities that simply involve registration are not sufficient. MIPS eligible clinicians and groups must participate for a minimum of 6 months. | ||
| Closing the Referral Loop: Receipt of Specialist Report | 43% | 53 |
| Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred | ||
| Documentation of Current Medications in the Medical Record | 91% | 3744 |
| Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration | ||
| e-Prescribing | 97% | 314 |
| At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology. | ||
| Implementation of medication management practice improvements | Yes | N/A |
| Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/or Conduct periodic, structured medication reviews. | ||
| Implementation of Use of Specialist Reports Back to Referring Clinician or Group to Close Referral Loop | Yes | N/A |
| Performance of regular practices that include providing specialist reports back to the referring individual MIPS eligible clinician or group to close the referral loop or where the referring individual MIPS eligible clinician or group initiates regular inquiries to specialist for specialist reports which could be documented or noted in the EHR technology. | ||
| Improved Practices that Engage Patients Pre-Visit | Yes | N/A |
| Implementation of workflow changes that engage patients prior to the visit, such as a pre-visit development of a shared visit agenda with the patient, or targeted pre-visit laboratory testing that will be resulted and available to the MIPS eligible clinician to review and discuss during the patient’s appointment.. | ||
| Pneumococcal Vaccination Status for Older Adults | 25% | 383 |
| Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine | ||
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | 31% | 542 |
| Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2 | ||
| Provide Patient Access | 98% | 395 |
| For at least one unique patient seen by the MIPS eligible clinician: (1) The patient (or the patient authorized representative) is provided timely access to view online, download, and transmit his or her health information; and (2) The MIPS eligible clinician ensures the patient's health information is available for the patient (or patient-authorized representative) to access using any application of their choice that is configured to meet the technical specifications of the Application Programing Interface (API) in the MIPS eligible clinician's certified EHR technology. | ||
| Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms. | Yes | N/A |
| Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms. | ||
| Security Risk Analysis | Yes | N/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. | ||
| Send a Summary of Care | 47% | 79 |
| For at least one transition of care or referral, the MIPS eligible clinician that transitions or refers their patient to another setting of care or health care provider-(1) creates a summary of care record using certified EHR technology; and (2) electronically exchanges the summary of care record. | ||
| Use of certified EHR to capture patient reported outcomes | Yes | N/A |
| In support of improving patient access, performing additional activities that enable capture of patient reported outcomes (e.g., home blood pressure, blood glucose logs, food diaries, at-risk health factors such as tobacco or alcohol use, etc.) or patient activation measures through use of certified EHR technology, containing this data in a separate queue for clinician recognition and review. | ||
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. Michael Whitlow is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| PIEDMONT AUGUSTA HOSPITAL | 1350 WALTON WAY AUGUSTA, GA 30901 | (706) 722-9011 | Acute Care Hospitals | |
| UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER | 2460 WASHINGTON ROAD THOMSON, GA 30824 | (706) 595-1411 | Acute Care Hospitals | |
| DOCTORS HOSPITAL | 3651 WHEELER ROAD AUGUSTA, GA 30909 | (706) 651-6008 | Acute Care Hospitals |
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 1 | 7 | 4 | 5 | 2 | 1 | 1 | 3 | 2 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 1 | 14 | 4 | 10 | 2 | 2 | 1 | 6 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 1 + 1 + 4 + 4 + 1 + 0 + 2 + 2 + 1 + 6 + 24 = 48 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 50 - 48 = 2 | 2 | ||||||||
The NPI number 1174521132 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 11 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1760480727 | NADEEM AFZAL MD Individual | Specialist | 1109 MEDICAL CENTER DR BUILDING #5 AUGUSTA, GA 30909 (706) 863-6637 |
| 1558361824 | DR. MICHAEL JOSEPH COHEN M.D. Individual | Specialist | 1109 MEDICAL CENTER DR SUITE 8B AUGUSTA, GA 30909 (706) 860-9210 |
| 1730168428 | DR. KELLY A MCSWEENEY MD Individual | Pathology (Anatomic Pathology & Clinical Pathology) | 1109 MEDICAL CENTER DR SUITE 1A AUGUSTA, GA 30909 (706) 651-6544 |
| 1588873400 | DR. RUSSELL S STEPHENS M.D. Individual | Anesthesiology (Pain Medicine) | 1109 MEDICAL CENTER DR 8A AUGUSTA, GA 30909 (706) 651-6322 |
| 1245422112 | COASTAL AIR, INC Organization | Ambulance (Air Transport) | 1109 MEDICAL CENTER DR BLDG 4 AUGUSTA, GA 30909 (706) 860-9100 |
| 1942408216 | STEPHENS CLINIC LLC Organization | Anesthesiology (Pain Medicine) | 1109 MEDICAL CENTER DR SUITE 8A AUGUSTA, GA 30909 (706) 863-7021 |
| 1164692786 | CSRA INTERNAL MEDICINE ASSOCIATES, PC Organization | Legal Medicine | 1109 MEDICAL CENTER DR SUITE 1A AUGUSTA, GA 30909 (706) 868-9797 |
| 1639161102 | AUDREY M HENDERSON M.D. Individual | Family Medicine | 1109 MEDICAL CENTER DR SUITE 3 AUGUSTA, GA 30909 (706) 860-4567 |
| 1396786760 | AUGUSTA RENAL PHYSICIANS, P.C. Organization | Internal Medicine (Nephrology) | 1109 MEDICAL CENTER DR BUILDING #5 AUGUSTA, GA 30909 (706) 863-6637 |
| 1114037629 | MICHAEL J. COHEN, M.D., P.C. Organization | Specialist | 1109 MEDICAL CENTER DR SUITE 8B AUGUSTA, GA 30909 (706) 860-9210 |
| 1437299211 | WEST AUGUSTA INTERNAL MEDICINE ASSOCIATES Organization | Internal Medicine (Endocrinology, Diabetes & Metabolism) | 1109 MEDICAL CENTER DR BUILDING 3 AUGUSTA, GA 30909 (706) 860-6824 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1174521132, enumerated in the NPI registry as an "individual" on July 13, 2005
The provider is located at 1109 Medical Center Dr Building #5 Augusta, Ga 30909 and the phone number is (706) 863-6637
The provider's speciality is Specialist with taxonomy code 174400000X
The provider has more than 51 years of experience. He graduated from Medical College Of Georgia School Of Medicine in 1975.
The provider might be accepting Accepts: Alliant Health Plans, Inc., BlueCross BlueShield. 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 most common procedures or services performed by this practitioner are: Dialysis services, per day, less than full month service (20 years or older), Established patient office or other outpatient visit, 30-39 minutes, Follow-up hospital inpatient care per day, typically 15 minutes, Follow-up hospital inpatient care per day, typically 25 minutes and Initial hospital inpatient care per day, typically 50 minutes.
The practitioner is affiliated to the following hospital(s): PIEDMONT AUGUSTA HOSPITAL, UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER and DOCTORS HOSPITAL. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
This NPI record was last updated on July 13, 2005. 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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