DR. ROBERTO A ARGUELLO M.D.
NPI 1538130521
Ophthalmology in Mcallen, TX
Quality Rating: 100 out of 100 score
NPI Status: Active since January 30, 2006
Contact Information
1910 S 1ST ST
SUITE 100
MCALLEN, TX
ZIP 78503
Phone: (956) 687-8475
Fax: (956) 687-4663
- Individual
- Male
- Ophthalmology
- Accepts Insurance
- PECOS Enrolled
- Medicare Quality Reporting
About ROBERTO ARGUELLO
This page provides the complete NPI Profile along with additional information for Roberto Arguello, a provider established in Mcallen, Texas with a medical specialization in Ophthalmology. The healthcare provider is registered in the NPI registry with number 1538130521 assigned on January 2006. The practitioner's primary taxonomy code is 207W00000X with license number G6260 (TX). The provider is registered as an individual and his NPI record was last updated 15 years ago.
- NPI
- 1538130521
- Provider Name
- DR. ROBERTO A ARGUELLO M.D.
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 1910 S 1ST ST SUITE 100 MCALLEN, TX 78503
- Location Phone
- (956) 687-8475
- Location Fax
- (956) 687-4663
- Mailing Address
- 1910 S 1ST ST SUITE 100 MCALLEN, TX 78503
- Mailing Phone
- (956) 687-8475
- Mailing Fax
- (956) 687-4663
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 01-30-2006
- Last Update Date
- 06-23-2010
- Code Navigator
Ophthalmologists like Roberto Arguello specialize in diagnosing and treating eye conditions. They may perform surgeries to correct vision issues or prevent vision loss due to diseases like glaucoma. Additionally, they can provide eyeglasses, prescribe contact lenses, and offer other vision-related services.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Ophthalmology
- Taxonomy Code
- 207W00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- G6260
- License State
- TX
- Taxonomy Description
- An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Advantage Bronze HMO? 204 - HMO
- Blue Advantage Bronze HMO? 301 - HMO
- Blue Advantage Bronze HMO? Standard - HMO
- Blue Advantage Gold HMO? 206 - HMO
- Blue Advantage Gold HMO? 603 - HMO
- Blue Advantage Gold HMO? Standard - HMO
- Blue Advantage Plus Bronze? 303 - POS
- Blue Advantage Plus Bronze? 305 - POS
- Blue Advantage Plus Bronze? Standard - POS
- Blue Advantage Plus Gold? 203 - POS
- Blue Advantage Plus Gold? 803 - POS
- Blue Advantage Plus Gold? Standard - POS
- Blue Advantage Plus Silver? 202 - POS
- Blue Advantage Plus Silver? 605 - POS
- Blue Advantage Plus Silver? Standard - POS
- Blue Advantage Security HMO? 200 - HMO
- Blue Advantage Silver HMO? 205 - HMO
- Blue Advantage Silver HMO? 801 - HMO
- Blue Advantage Silver HMO? Standard - HMO
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 |
|---|---|---|---|
| B20956 | MEDICARE UPIN (02) | TX | |
| 110250102 | MEDICAID (05) | TX | |
| 00AD03 | MEDICARE PIN (08) | TX |
Medicare Participation & PECOS Enrollment Status
Roberto Arguello 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
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.
Established patient complete exam of visual system
Established patient problem focused exam of visual system
Exam of the internal drainage system of eye
Exam of visual field with extended testing
Imaging of optic nerve
New patient complete exam of visual system
New patient problem focused exam of visual system
Photography of content of eyes
Photography of the retina
Removal of recurring cataract in lens capsule using a laser
Ultrasound scan of cornea to determine thickness
An established patient complete exam of the visual system involves a thorough check of your eyes and vision. It assesses eye health, checks for diseases, and measures your ability to see clearly at different distances. It's a routine, non-invasive procedure.
This service was performed 445 times for 435 patientsThis is a routine check-up for existing patients focusing on the visual system. It involves examining your eyes to detect any potential issues or changes in your vision. It's a crucial part of maintaining good eye health.
This service was performed 821 times for 424 patientsThis is a procedure where your doctor examines the eye's internal drainage system, essential for maintaining eye pressure. They use specialized tools to check for blockages or damage that might lead to conditions like glaucoma. It's non-invasive and painless.
This service was performed 29 times for 29 patientsAn extended visual field exam is a detailed test to evaluate your peripheral (side) vision. It helps to detect any potential blind spots which may not be noticeable in daily life. These could be caused by eye diseases like glaucoma, or neurological conditions.
This service was performed 119 times for 118 patientsImaging of the optic nerve is a non-invasive procedure that captures detailed pictures of your optic nerve. It helps doctors assess eye health, particularly for conditions like glaucoma. It's painless, quick, and uses safe technology like MRI or OCT (Optical Coherence Tomography).
This service was performed 177 times for 177 patientsA new patient complete exam of the visual system is a thorough evaluation of your eyes and vision. It checks for any potential issues and assesses overall eye health. It includes tests for visual acuity, eye movement, and light response.
This service was performed 80 times for 80 patientsA new patient problem-focused exam of the visual system is a basic evaluation of your eyes and vision. It includes checking your eye movements, visual acuity, and general eye health. It helps detect any potential issues early for timely treatment.
This service was performed 16 times for 16 patientsPhotography of the content of eyes, also known as ocular photography, captures detailed images of different parts of the eye. It helps identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. The process is non-invasive and painless.
This service was performed 16 times for 15 patientsPhotography of the retina, also known as retinal imaging, is a non-invasive procedure that captures images of the back of your eye. This helps doctors identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. It's painless and quick, often part of a routine eye exam.
This service was performed 24 times for 24 patientsThis procedure, known as YAG laser capsulotomy, treats cloudiness in the lens capsule following cataract surgery. A laser is used to create a small hole in the cloudy capsule, allowing light to pass through and restore clear vision. It's a quick, painless procedure.
This service was performed 14 times for 13 patientsAn ultrasound scan of the cornea is a non-invasive procedure that uses sound waves to measure the thickness of your cornea. This helps in diagnosing certain eye conditions and planning treatments. No discomfort or pain is typically experienced.
This service was performed 28 times for 28 patientsPhysician Visit Costs
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 78503 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $126.4
- Minimum New Patient Price $54.84
- Maximum New Patient Price $166.88
- Average New Patient Copayment $31.6
- Minimum New Patient Copayment $13.71
- Maximum New Patient Copayment $41.72
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $68.55
- Minimum Established Patient Price $17.52
- Maximum Established Patient Price $136.11
- Average Established Patient Copayment $17.13
- Minimum Established Patient Copayment $4.38
- Maximum Established Patient Copayment $34.02
* 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 100, 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.
-
Final Score: 100 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: 96.48
The Quality category assesses providers performance on clinical practices and patient outcomes under the traditional MIPS program. The quality measures help identify the quality of healthcare processes, outcomes, and patient experiences. The Quality measure category compromises 40% providers final MPIS scores.
There are six collection types for MIPS quality measures: Electronic Clinical Quality Measures (eCQMs), MIPS Clinical Quality Measures (CQMs), Qualified Clinical Data Registry (QCDR) Measures, Medicare Part B claims measures, CMS Web Interface measures and The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey.
-
Promoting Interoperability Score: N/A
The Interoperability category measures the providers ability to use technology to exchange and make use of healthcare information in a way that is less burdensome and improves outcomes. The Interoperability measure category compromises 25% providers final MPIS scores.
The MIPS Interoperability measure focuses on the use of certified electronic health record technology (CEHRT) to improve patient access health information, the exchange of information between clinicians and pharmacies and the systematic collection, analysis, and interpretation of healthcare data. -
Improvement Activities Score: 40
The Improvement Activities performance category evaluates the providers participation in clinical activities that support the improvement of clinical practice, care delivery, and outcomes. Providers have the option to choose 2 to 4 activities from an inventory of over 100 improvement activities. Providers typically choose the activities that best fit their needs. The improvement activities measure category compromises 15% providers final MPIS scores.
The Improvement measures aim to better patient engagement, patient safety and other areas of patient care. The Improvement Activities category compromises 15% of providers final MPIS scores. -
Cost Score: N/A
The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.
Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores. -
Cost Score: N/A
The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.
Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.
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 |
|---|---|---|
| Closing the Referral Loop: Receipt of Specialist Report | 68% | 60 |
| Diabetes: Eye Exam | 100% | 1376 |
| Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care | 74% | 290 |
| Documentation of Current Medications in the Medical Record | 100% | 7781 |
| Glaucoma Intraocular Pressure Reduction | 99% | 1177 |
| Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation | 96% | 836 |
Reviews for DR. ROBERTO A ARGUELLO M.D.
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
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 | 5 | 3 | 8 | 1 | 3 | 0 | 5 | 2 | 1 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 5 | 6 | 8 | 2 | 3 | 0 | 5 | 4 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 5 + 6 + 8 + 2 + 3 + 0 + 5 + 4 + 24 = 59 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 59 = 1 | 1 | ||||||||
The NPI number 1538130521 is valid because the calculated check digit 1 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 5 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1467458422 | RUY MIRELES QUINTANILLA Individual | Specialist | 1910 S 1ST ST STE 200 MCALLEN, TX 78503 (956) 687-7885 |
| 1437194875 | SOUTH TEXAS NEUROLOGICAL CENTER, P.A. Organization | Psychiatry & Neurology (Neurology) | 1910 S 1ST ST SUITE 200 MCALLEN, TX 78503 (956) 687-7885 |
| 1508897935 | ERROL OLWYN GRANNUM MD Individual | Ophthalmology | 1910 S 1ST ST MCALLEN, TX 78503 (956) 687-3937 |
| 1851832448 | TEXAS BIONICS, INC Organization | Prosthetic/Orthotic Supplier | 1910 S 1ST ST SUITE 500 MCALLEN, TX 78503 (956) 994-9528 |
| 1457377194 | ERROL O GRANNUM Organization | Ophthalmology | 1910 S 1ST ST SUITE 400 MCALLEN, TX 78503 (956) 687-3937 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1538130521, enumerated in the NPI registry as an "individual" on January 30, 2006
The provider is located at 1910 S 1st St Suite 100 Mcallen, Tx 78503 and the phone number is (956) 687-8475
The provider's speciality is Ophthalmology with taxonomy code 207W00000X
The provider might be accepting Accepts: Blue Cross and Blue Shield of Texas, Medicare and. 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: Closing the Referral Loop: Receipt of Specialist Report, Diabetes: Eye Exam, Documentation of Current Medications in the Medical Record, Glaucoma Intraocular Pressure Reduction , Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation. 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 $126.4 with an average copayment of $31.6 for new patient appointments. Established patients should expect a typical charge of $68.55 and an average copayment of 17.13. 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: Established patient complete exam of visual system, Established patient problem focused exam of visual system, Exam of the internal drainage system of eye, Exam of visual field with extended testing, Imaging of optic nerve, New patient complete exam of visual system, New patient problem focused exam of visual system, Photography of content of eyes, Photography of the retina, Removal of recurring cataract in lens capsule using a laser and Ultrasound scan of cornea to determine thickness.
This NPI record was last updated on January 30, 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].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.