PAUL ANTHONY SCOTT SR. M.D.
NPI 1528161924
Urology in Mobile, AL

Medicare Participation & PECOS Enrollment Status

Paul Scott 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.

Paul Scott 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: 7618871708

  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: I20031120000789, I20040311000066

  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-Medical/Surgical Supplies (DA000N)

  Lubricant, individual sterile packet, each (HCPCS:A4332)

  1 DME suppliers used 12 Medicare Claims 1440 Services Paid

• DME-Medical/Surgical Supplies (DA000N)

  Adhesive remover, wipes, any type, each (HCPCS:A4456)

  2 DME suppliers used 16 Medicare Claims 950 Services Paid

Orthotic Devices

• DME-Orthotic Devices (DF008N)

  Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each (HCPCS:A4351)

  3 DME suppliers used 24 Medicare Claims 3061 Services Paid

• DME-Orthotic Devices (DF008N)

  Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, silicone elastomeric, or hydrophilic, etc.), each (HCPCS:A4352)

  1 DME suppliers used 14 Medicare Claims 1380 Services Paid

• DME-Orthotic Devices (DF000N)

  Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each (HCPCS:A4357)

  4 DME suppliers used 26 Medicare Claims 52 Services Paid

• DME-Orthotic Devices (DF010N)

  Skin barrier; solid, 4 x 4 or equivalent; each (HCPCS:A4362)

  3 DME suppliers used 12 Medicare Claims 270 Services Paid

• DME-Orthotic Devices (DF010N)

  Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each (HCPCS:A4385)

  2 DME suppliers used 12 Medicare Claims 240 Services Paid

• DME-Orthotic Devices (DF010N)

  Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each (HCPCS:A4430)

  3 DME suppliers used 19 Medicare Claims 475 Services Paid

• DME-Orthotic Devices (DF010N)

  Skin barrier, wipes or swabs, each (HCPCS:A5120)

  2 DME suppliers used 13 Medicare Claims 400 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 hormonal anti-neoplastic chemotherapy under skin or into muscle

This procedure involves the injection of hormone-based anti-cancer drugs under the skin or into a muscle. These medications help to slow down or stop the growth of certain types of cancer cells. The process is usually quick and can be performed in a clinic or hospital.

This service was performed 28 times for 17 patients

Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle

This 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 38 times for 22 patients

Advance care planning, first 30 minutes

Advance care planning is a process where you discuss your healthcare preferences with your doctor. This conversation, lasting up to 30 minutes, helps ensure your wishes are respected if you're unable to communicate them in the future. It's about your care, your way.

This service was performed 30 times for 20 patients

Biopsy of prostate gland

A biopsy of the prostate gland is a procedure where a small sample of tissue is taken from your body's internal gland, located near the bladder, for testing. This helps in diagnosing potential health issues. It's usually done with a fine needle and imaging technology for accuracy.

This service was performed 18 times for 18 patients

Blood count, hemoglobin

A blood count, specifically hemoglobin, is a standard test that measures the amount of hemoglobin in your blood. Hemoglobin is a protein in red blood cells that carries oxygen throughout your body. This test helps assess your overall health and detect a variety of disorders such as anemia or polycythemia.

This service was performed 44 times for 25 patients

Blood creatinine level

A blood creatinine level test measures the amount of creatinine in your blood. Creatinine is a waste product that your body produces when it uses energy. High levels may indicate that your kidneys aren't working properly. This test is often used to monitor kidney health.

This service was performed 44 times for 43 patients

Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month

Chronic care management services involve a healthcare professional directing clinical staff in managing your chronic conditions. This includes the first 20 minutes per month of services like medication management, care coordination, and health monitoring to help improve your health and quality of life.

This service was performed 524 times for 86 patients

Complete ultrasound scan behind abdominal cavity

A complete ultrasound scan behind the abdominal cavity is a non-invasive imaging procedure. It uses sound waves to create pictures of the structures and organs located at the back of your abdomen. It helps in diagnosing health conditions and monitoring ongoing treatments.

This service was performed 187 times for 154 patients

Complex chronic care management services for two or more chronic conditions, first 60 minutes of clinical staff time directed by health care professional, per calendar month

Complex chronic care management is a service for patients with two or more long-term health conditions. It involves a healthcare professional directing clinical staff in providing care for the first 60 minutes each month. This helps manage your health conditions effectively.

This service was performed 190 times for 30 patients

Ct scan of abdomen and pelvis before and after contrast

A CT scan of your abdomen and pelvis with and without contrast helps visualize your internal organs better. Contrast is a special dye that improves the clarity of the images. It's taken orally or injected into your veins before the scan. The process is painless and quick.

This service was performed 45 times for 45 patients

Ct scan of abdomen and pelvis without contrast

A CT scan of the abdomen and pelvis is a non-invasive medical test. It uses special X-ray equipment to create detailed images of your abdominal and pelvic areas. This helps doctors examine organs, tissues, and vessels. No contrast dye is used in this procedure.

This service was performed 30 times for 30 patients

Destruction of growth of bladder and urethra using an endoscope, less than 0.5 cm

This procedure involves using a special instrument called an endoscope to remove a small growth in your bladder and urethra. It's a minimally invasive procedure and the growth being treated is less than half a centimeter in size.

This service was performed 15 times for 13 patients

Detection test by nucleic acid for organism, amplified probe technique

A nucleic acid detection test is a procedure to identify specific organisms in your body. This test uses an amplified probe technique, which magnifies the genetic material of the organism, making it easier to detect. It's a precise way to diagnose infections.

This service was performed 663 times for 42 patients

Detection test by nucleic acid for staphylococcus aureus (bacteria), amplified probe technique

A detection test for Staphylococcus aureus uses a method called the amplified probe technique. This method identifies the bacteria's unique genetic material, or nucleic acid, helping to confirm its presence. It's a highly accurate way to detect this type of bacteria.

This service was performed 52 times for 43 patients

Detection test by nucleic acid for strep (streptococcus, group b), amplified probe technique

A detection test by nucleic acid for Group B Strep uses an amplified probe technique. This test identifies the presence of Group B Strep bacteria in the body. It involves collecting a sample, usually a swab, which is then examined in a lab for the bacteria's genetic material.

This service was performed 52 times for 43 patients

Detection test by nucleic acid for vancomycin resistance strep (vre), amplified probe technique

The detection test by nucleic acid for vancomycin-resistant strep (VRE) is a laboratory procedure. It uses an amplified probe technique to identify specific genetic material in bacteria. This helps determine if the bacteria are resistant to the antibiotic vancomycin.

This service was performed 11 times for 11 patients

Detection test for candida species (yeast), amplified probe technique

This test helps identify Candida, a type of fungus often present in the human body. An amplified probe technique is used, which enhances detection of the fungus in a sample. This method increases the accuracy of the test, helping to determine the best treatment.

This service was performed 52 times for 43 patients

Diagnostic exam of bladder and urethra using an endoscope

This procedure involves using a thin, flexible tube with a light, called an endoscope, to examine the bladder and urethra. It helps in identifying any abnormalities or issues that may be causing discomfort or other symptoms.

This service was performed 109 times for 95 patients

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

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

This service was performed 244 times for 217 patients

Established patient office or other outpatient visit, 40-54 minutes

This 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 869 times for 498 patients

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

Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.

This service was performed 64 times for 40 patients

Hospital observation or inpatient care admitted and discharged on the same day for high severity problem, typically 55 minutes

This service involves a brief hospital stay for a serious health issue. Patients are admitted and discharged on the same day, typically within 55 minutes. It allows for close monitoring and immediate treatment, ensuring optimal care.

This service was performed 42 times for 38 patients

Initial hospital inpatient care per day, typically 70 minutes

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

This service was performed 47 times for 46 patients

Injection, denosumab, 1 mg

Denosumab 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 2,700 times for 22 patients

Insertion of needle into vein for collection of blood sample

This 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 724 times for 404 patients

Insertion of tube into ureter using an endoscope through bladder area

This procedure involves the use of a thin, flexible tool called an endoscope. It's inserted through the body's natural pathways to reach the area where urine is transported. A small tube is then placed in this area to help with urine flow or to remove blockages.

This service was performed 12 times for 12 patients

Leuprolide acetate (for depot suspension), 7.5 mg

Leuprolide acetate is a medication that helps regulate certain hormone levels in your body. It's injected into your muscle once a month. This treatment can help manage various health conditions related to hormone imbalance. Always follow your doctor's instructions.

This service was performed 168 times for 17 patients

Manual urinalysis test with examination using microscope, non-automated

A manual urinalysis test involves studying a urine sample under a microscope. This non-automated method helps identify any abnormal substances present. It's a useful tool for detecting potential health concerns early. The process is simple and non-invasive.

This service was performed 990 times for 596 patients

New patient office or other outpatient visit, 60-74 minutes

This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.

This service was performed 85 times for 85 patients

Prostate resection

Prostate resection is a procedure performed to alleviate discomfort caused by an enlarged prostate. This involves removing a portion of the prostate gland to ease pressure on the urinary tract, improving urine flow and reducing symptoms. It's performed under general or spinal anesthesia.

This service was performed for 15 patients

Psa (prostate specific antigen) measurement, total

PSA measurement is a simple blood test that checks for a specific protein produced by your body. High levels could indicate a health issue that needs further investigation. It's often used to monitor general wellness and is part of routine health screening.

This service was performed 591 times for 328 patients

Red blood cell concentration measurement

Red blood cell concentration measurement is a routine blood test that assesses the number of red blood cells in your blood. These cells carry oxygen throughout your body. The test can help identify conditions like anemia or dehydration. It's a simple, quick, and relatively painless procedure.

This service was performed 44 times for 25 patients

Telephone medical discussion with physician, 11-20 minutes

This is a service where you have a phone conversation with your doctor for 11-20 minutes. It's used for discussing health concerns, reviewing test results, or managing ongoing conditions. It's a convenient way to receive medical advice without an in-person visit.

This service was performed 302 times for 208 patients

Testosterone (hormone) level, total

A total testosterone level test measures the amount of a key hormone in your body. This hormone influences various body functions such as muscle mass, energy levels, and mood. The test involves a simple blood draw, and results help monitor health conditions.

This service was performed 95 times for 54 patients

Ultrasonic guidance for needle placement

Ultrasonic guidance for needle placement is a technique where sound waves create images that help accurately position the needle during procedures. This method ensures precision, minimizes discomfort, and increases safety.

This service was performed 18 times for 18 patients

Ultrasound measurement of bladder capacity after voiding

Ultrasound measurement of bladder capacity after voiding is a non-invasive test that uses sound waves to create images of your bladder. It's done after you've emptied your bladder to see if there's any leftover urine, which can help diagnose certain conditions.

This service was performed 44 times for 42 patients

Ultrasound scan of pelvic region through rectum

An ultrasound scan of the pelvic region through the rectum is a medical procedure where a small, smooth device is gently inserted into the rectum. This device uses sound waves to create images of the internal structures in the lower abdomen, aiding in diagnosis and treatment planning.

This service was performed 18 times for 18 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $30.57 for a new patient copayment and $16.52 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 36607 ZIP code area.

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Overall MIPS Quality Performance

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 70.4, 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: 70.4 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: 68.78

  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: 65

  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: 61.73

  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: 61.73

  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.

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. Paul Scott is affiliated with the following medical facilities:

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NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

The NPI number 1528161924 is valid because the calculated check digit 4 using the Luhn validation algorithm matches the last digit of the original NPI number.

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The following 20 providers are registered at the same or nearby location.

Frequently Asked Questions