DR. DENIS P RALEIGH MD
NPI 1427069855
Thoracic Surgery (Cardiothoracic Vascular Surgery) in Idaho Falls, ID
NPI Status: Active since August 10, 2006
Contact Information
3200 CHANNING WAY STE 205
IDAHO FALLS, ID
ZIP 83404
Phone: (208) 535-4580
- Individual
- Male
- Years of Experience 43
- Thoracic Surgery (Cardiothoracic Vascula...
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
- Medicare Quality Reporting
About DENIS RALEIGH
This page provides the complete NPI Profile along with additional information for Denis Raleigh, a provider established in Idaho Falls, Idaho with a medical specialization in Thoracic Surgery (cardiothoracic Vascular Surgery) and more than 43 years of experience. The healthcare provider is registered in the NPI registry with number 1427069855 assigned on August 2006. The practitioner's primary taxonomy code is 208G00000X with license number MC-0944 (ID). The provider is registered as an individual and his NPI record was last updated 2 years ago.
- NPI
- 1427069855
- Provider Name
- DR. DENIS P RALEIGH MD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 3200 CHANNING WAY STE 205 IDAHO FALLS, ID 83404
- Location Phone
- (208) 535-4580
- Mailing Address
- PO BOX 277381 ATLANTA, GA 30384
- Medical School Name
- OTHER
- Graduation Year
- 1983
- Is Sole Proprietor?
- No
- Enumeration Date
- 08-10-2006
- Last Update Date
- 08-10-2023
- 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
Thoracic Surgery (Cardiothoracic Vascular Surgery)
- Taxonomy Code
- 208G00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- MC-0944
- License State
- ID
- Taxonomy Description
- A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Essentia Choice Care with Medica Bronze $0 Copay PCP Visits - HMO
- Essentia Choice Care with Medica Bronze HSA - EPO
- Essentia Choice Care with Medica Bronze Share - EPO
- Essentia Choice Care with Medica Bronze Share - HMO
- Essentia Choice Care with Medica Expanded Bronze Standard - EPO
- Essentia Choice Care with Medica Expanded Bronze Standard - HMO
- Essentia Choice Care with Medica Gold $0 Copay PCP Visits - EPO
- Essentia Choice Care with Medica Gold $0 Copay PCP Visits - HMO
- Essentia Choice Care with Medica Gold Share - EPO
- Essentia Choice Care with Medica Gold Share - HMO
- Essentia Choice Care with Medica Gold Standard - EPO
- Essentia Choice Care with Medica Gold Standard - HMO
- Essentia Choice Care with Medica Silver $0 Copay PCP Visits - EPO
- Essentia Choice Care with Medica Silver $0 Copay PCP Visits - HMO
- Essentia Choice Care with Medica Silver Share - EPO
- Essentia Choice Care with Medica Silver Share - HMO
- Essentia Choice Care with Medica Silver Standard - EPO
- Essentia Choice Care with Medica Silver Standard - HMO
- Medica Individual Choice Bronze $0 Copay PCP Visits - HMO
- Medica Individual Choice Bronze HSA - EPO
- Moda Select Bronze 8700 ($0 Virtual Urgent Care through CirrusMD) - EPO
- Moda Select Bronze HDHP 7500 - EPO
- Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - EPO
- Moda Select Gold 1800 ($0 Virtual Urgent Care through CirrusMD) - EPO
- Moda Select Silver 3500 ($0 Virtual Urgent Care through CirrusMD) - EPO
- Moda Select Silver 4800 ($0 Virtual Urgent Care through CirrusMD) - EPO
- Moda Select Silver 6400 ($0 Virtual Urgent Care through CirrusMD) - EPO
- Moda Select Texas Standard Bronze - EPO
- Moda Select Texas Standard Gold - EPO
- Moda Select Texas Standard Silver - EPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medicare Participation & PECOS Enrollment Status
Denis Raleigh 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.
Denis Raleigh 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: 941219497
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: I20230105001907
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.
Coronary artery bypass graft (CABG)
Coronary artery bypass graft (CABG) is a surgery to improve blood flow to your heart. It involves taking a blood vessel from another part of your body and using it to reroute blood around a blocked or narrowed artery in your heart. This can help reduce chest pain and minimize the risk of heart attacks.
This service was performed for 15 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $40.04 for a new patient copayment and $16.44 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 83404 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99205
- Average New Patient Price $160.17
- Minimum New Patient Price $52.44
- Maximum New Patient Price $160.17
- Average New Patient Copayment $40.04
- Minimum New Patient Copayment $13.11
- Maximum New Patient Copayment $40.04
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $65.77
- Minimum Established Patient Price $16.68
- Maximum Established Patient Price $130.93
- Average Established Patient Copayment $16.44
- Minimum Established Patient Copayment $4.17
- Maximum Established Patient Copayment $32.73
* 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.
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 |
|---|---|---|
| Chronic Care and Preventative Care Management for Empaneled Patients | Yes | N/A |
| Proactively manage chronic and preventive care for empaneled patients that could include one or more of the following: • Provide patients annually with an opportunity for development and/or adjustment of an individualized plan of care as appropriate to age and health status, including health risk appraisal; gender, age and condition-specific preventive care services; and plan of care for chronic conditions; • Use condition-specific pathways for care of chronic conditions (e.g., hypertension, diabetes, depression, asthma and heart failure) with evidence-based protocols to guide treatment to target; such as a CDC-recognized diabetes prevention program; • Use pre-visit planning to optimize preventive care and team management of patients with chronic conditions; • Use panel support tools (registry functionality) to identify services due; • Use predictive analytical models to predict risk, onset and progression of chronic diseases; or • Use reminders and outreach (e.g., phone calls, emails, postcards, patient portals and community health workers where available) to alert and educate patients about services due; and/or routine medication reconciliation. | ||
| Colorectal Cancer Screening | 4% | 46 |
| Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer | ||
| Documentation of Current Medications in the Medical Record | 100% | 84 |
| 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 | ||
| 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. | ||
| Measurement and Improvement at the Practice and Panel Level | Yes | N/A |
| Measure and improve quality at the practice and panel level, such as the American Board of Orthopaedic Surgery (ABOS) Physician Scorecards, that could include one or more of the following: • Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice level and at the level of the care team or MIPS eligible clinician or group (panel); and/or • Use relevant data sources to create benchmarks and goals for performance at the practice level and panel level. | ||
| Patient-Specific Education | 20% | 89 |
| 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: Body Mass Index (BMI) Screening and Follow-Up Plan | 28% | 67 |
| 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 | 65% | 89 |
| 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. | ||
| Secure Messaging | 1% | 89 |
| For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period. | ||
| 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. | ||
| Specialized Registry Reporting | Yes | N/A |
| The MIPS eligible clinician is in active engagement to submit data to specialized registry. To earn a 5 % bonus in the promoting interoperability performance category score for submitting to one or more public health or clinical data registries also attest to PI_TRANS_PHCDRR_3_MULTI. | ||
| Use of decision support and standardized treatment protocols | Yes | N/A |
| Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs. | ||
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. Denis Raleigh is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| EASTERN IDAHO REGIONAL MEDICAL CENTER | 3100 CHANNING WAY IDAHO FALLS, ID 83404 | (208) 529-6111 | Acute Care Hospitals | |
| MADISON MEMORIAL HOSPITAL | 450 EAST MAIN STREET REXBURG, ID 83440 | (208) 359-6900 | 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 | 4 | 2 | 7 | 0 | 6 | 9 | 8 | 5 | 5 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 4 | 4 | 7 | 0 | 6 | 18 | 8 | 10 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 4 + 4 + 7 + 0 + 6 + 1 + 8 + 8 + 1 + 0 + 24 = 65 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 65 = 5 | 5 | ||||||||
The NPI number 1427069855 is valid because the calculated check digit 5 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 3 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1578925780 | RACHAEL SNOW M.D. Individual | Surgery (Vascular Surgery) | 3200 CHANNING WAY STE 205 IDAHO FALLS, ID 83404 (208) 535-4580 |
| 1861788937 | DR. JACOB WILLIAM WENDLING D.O. Individual | Internal Medicine (Gastroenterology) | 3200 CHANNING WAY STE 205 IDAHO FALLS, ID 83404 (208) 535-4580 |
| 1033123658 | MATTHEW G TAYLOR MD Individual | Internal Medicine (Clinical Cardiac Electrophysiology) | 3200 CHANNING WAY STE 205 IDAHO FALLS, ID 83404 (208) 535-4580 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1427069855, enumerated in the NPI registry as an "individual" on August 10, 2006
The provider is located at 3200 Channing Way Ste 205 Idaho Falls, Id 83404 and the phone number is (208) 535-4580
The provider's speciality is Thoracic Surgery (Cardiothoracic Vascular Surgery) with taxonomy code 208G00000X
The provider has more than 43 years of experience.
The provider might be accepting Accepts: Medica and Moda Health Plan, Inc.. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
Medicare beneficiaries should expect a typical cost of $160.17 with an average copayment of $40.04 for new patient appointments. Established patients should expect a typical charge of $65.77 and an average copayment of 16.44. 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: Coronary artery bypass graft (CABG).
The practitioner is affiliated to the following hospital(s): EASTERN IDAHO REGIONAL MEDICAL CENTER and MADISON MEMORIAL 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 August 10, 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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