TIMOTHY DOWNEY WAGNER MD, MBA
NPI 1619169935
Radiology - Radiation Oncology in San Antonio, TX

Medicare Participation & PECOS Enrollment Status

Timothy Wagner 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.

Timothy Wagner 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: 6406070168

  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: I20140619001223

  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.

Calculation of radiation therapy dose

Radiation therapy dose calculation is a process to determine the exact amount of radiation needed to treat a specific area in the body. This calculation helps ensure the treatment is effective while minimizing harm to healthy tissues. It's a key part of planning your radiation therapy.

This service was performed 206 times for 46 patients

Complex radiation therapy planning

Complex radiation therapy planning is a process to determine the most effective way to deliver radiation to a specific area in your body. It involves detailed imaging to map your body's structure, allowing for precise targeting of cancer cells while sparing healthy tissue.

This service was performed 52 times for 47 patients

Continuing radiation therapy consultation per week

Continuing radiation therapy consultation per week involves regular meetings with your healthcare team. These sessions help monitor your progress, manage side effects, and adjust your treatment plan if necessary. It's a key part of ensuring the effectiveness of your radiation therapy.

This service was performed 176 times for 46 patients

Ct guidance for insertion of radiation therapy fields

CT guidance for insertion of radiation therapy fields involves using a CT scan to accurately map the area of your body where radiation will be applied. This ensures the radiation targets only the necessary area, minimizing impact to healthy tissues.

This service was performed 537 times for 119 patients

Design and construction of complex radiation treatment device

The design and construction of a complex radiation treatment device is a process where a specialized instrument is created. This device targets harmful cells with high-energy rays to destroy or damage them, while minimizing impact on healthy cells. This aids in treating conditions like cancer.

This service was performed 112 times for 46 patients

Design and construction of radiation treatment device for high precision radiation therapy

A radiation treatment device is custom-made for each patient to target cancer cells with high precision. It's designed to focus radiation on the tumor, sparing healthy tissue. This process ensures effective therapy while minimizing side effects.

This service was performed 52 times for 42 patients

Established patient office or other outpatient visit, 20-29 minutes

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

This service was performed 17 times for 15 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 64 times for 44 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 18 times for 16 patients

High precision radiation therapy planning

High precision radiation therapy planning involves detailed mapping of your body to target cancer cells accurately. Advanced imaging techniques help identify the exact location of the tumor, minimizing harm to healthy tissues. This personalized approach enhances effectiveness and reduces side effects.

This service was performed 51 times for 42 patients

Intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session

Intensity-modulated radiation therapy (IMRT) is a type of cancer treatment. It uses advanced technology to manipulate photon beams of radiation to conform to the shape of a tumor. IMRT allows for the radiation dose to conform more precisely to the three-dimensional shape of the tumor by modulating—or controlling—the intensity of the radiation beam. This can result in better tumor control and less harm to healthy tissue.

This service was performed 850 times for 68 patients

Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml

Low osmolar contrast material with 300-399 mg/ml iodine concentration is a diagnostic tool used in imaging procedures. It helps to enhance the visibility of specific areas in the body, aiding in accurate diagnosis. It's safe and generally well-tolerated by patients.

This service was performed 3,461 times for 30 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 37 times for 37 patients

Obtaining data needed to develop the optimal radiation treatment, 3 or more treatment areas or any number of treatment areas where special treatment is involved

This procedure involves collecting necessary data to plan the best radiation treatment. It may cover 3 or more areas or any area requiring special attention. Data collection includes imaging scans and tests to understand the disease's extent and to tailor a precise, effective treatment plan.

This service was performed 13 times for 11 patients

Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 11-19 mev

This procedure involves using high-energy radiation to target and treat disease. It covers 3 or more distinct areas, using custom blocks to protect healthy tissue. Tangential ports, wedges, and rotational beams help direct the radiation. An electron beam of 11-19 million electron volts (mev) is used for deep-seated conditions.

This service was performed 21 times for 13 patients

Radiation treatment management, 5 treatment sessions

Radiation treatment management involves a series of 5 sessions where targeted radiation is used to destroy or shrink cancer cells in your body. Each session is carefully planned to maximize effectiveness while minimizing harm to healthy tissues. You may experience side effects which will be closely monitored and managed for your comfort.

This service was performed 169 times for 55 patients

Special medical radiation therapy consultation

A special medical radiation therapy consultation involves discussing the use of high-energy radiation to treat diseases, primarily cancer. It's a chance to understand the process, potential side effects, and benefits. It is a key step in planning your treatment.

This service was performed 47 times for 38 patients

Special radiation treatment

Special radiation treatment is a medical procedure that uses high-energy rays to destroy or damage cancer cells. It's a targeted approach that aims to minimize harm to healthy tissues. The treatment duration varies based on individual health conditions.

This service was performed 25 times for 24 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $41.72 for a new patient copayment and $17.13 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 78229 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 98.8, 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: 98.8 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: 80.7

  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: 100

  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.

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. Timothy Wagner 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 1619169935 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 4 providers are registered at the same or nearby location.

Frequently Asked Questions