THOMAS W JOHNSON MD
NPI 1659476182
Surgery in Southbridge, MA


Quality Rating: 90.62 out of 100 score

NPI Status: Active since September 13, 2006

Contact Information

100 SOUTH ST
SUITE 108
SOUTHBRIDGE, MA
ZIP 01550
Phone: (508) 764-6966
Fax: (508) 764-2457

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  • Individual
  • Male
  • Years of Experience 30
  • Surgery
  • Accepts Insurance
  • Accepts Medicare Approved Payment
  • PECOS Enrolled

About THOMAS JOHNSON

This page provides the complete NPI Profile along with additional information for Thomas Johnson, a provider established in Southbridge, Massachusetts with a medical specialization in Surgery and more than 30 years of experience. He graduated from Medical College Of Pennsylvania in 1996. The healthcare provider is registered in the NPI registry with number 1659476182 assigned on September 2006. The practitioner's primary taxonomy code is 208600000X with license number 216119 (MA). The provider is registered as an individual and his NPI record was last updated 10 years ago.

NPI
1659476182
Provider Name
THOMAS W JOHNSON MD
Gender
Male
Entity Type
Individual
Location Address
100 SOUTH ST SUITE 108 SOUTHBRIDGE, MA 01550
Location Phone
(508) 764-6966
Location Fax
(508) 764-2457
Mailing Address
PO BOX 40 SOUTHBRIDGE, MA 01550
Mailing Phone
(508) 909-7799
Mailing Fax
(508) 764-2457
Medical School Name
MEDICAL COLLEGE OF PENNSYLVANIA
Graduation Year
1996
Is Sole Proprietor?
No
Enumeration Date
09-13-2006
Last Update Date
09-30-2015
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A surgeon like Thomas Johnson treats injuries, diseases, and deformities through surgical operations. A surgeon could correct physical deformities, repair bone and tissue, or perform preventive or elective surgeries. Surgeons also examine patients, perform and interpret diagnostic tests, and provide counsel on preventive healthcare.

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

Surgery

Taxonomy Code
208600000X
Type
Allopathic & Osteopathic Physicians
License No.
216119
License State
MA
Taxonomy Description
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Anthem Bronze Access Blue New England HMO 5000/10%/8000 w/HSA - HMO
  • Anthem Bronze Access Blue New England HMO 5000/20%/8000 w/HSA - HMO
  • Anthem Bronze Access Blue New England HMO 6500/30%/9200 Value - HMO
  • Anthem Bronze Access Blue New England HMO 7000/50%/8000 w/HSA - HMO
  • Anthem Bronze Access Blue New England HMO 8500/50%/9200 - HMO
  • Anthem Gold Access Blue New England HMO 1000/20%/7500 - HMO
  • Anthem Gold Access Blue New England HMO 2000/0%/6500 RxD - HMO
  • Anthem Gold Access Blue New England HMO 2000/10%/4600 w/HSA - HMO
  • Anthem Gold Access Blue New England HMO 2000/10%/7500 - HMO
  • Anthem Gold Access Blue New England HMO 2000/20%/4600 w/HSA - HMO
  • Anthem Gold Access Blue New England HMO 3000/0%/5500 RxD - HMO
  • Anthem Gold Access Blue New England HMO 500/25%/7000 - HMO
  • Anthem Platinum Access Blue New England HMO 250/10%/3500 - HMO
  • Anthem Silver Access Blue New England HMO 2000/30%/9000 Value - HMO
  • Anthem Silver Access Blue New England HMO 3000/20%/8500 - HMO
  • Anthem Silver Access Blue New England HMO 3000/30%/9000 Value - HMO
  • Anthem Silver Access Blue New England HMO 3500/20%/7250 w/HSA - HMO
  • Anthem Silver Access Blue New England HMO 4000/0%/8500 - HMO
  • Anthem Silver Access Blue New England HMO 4000/0%/8500 RxD - HMO
  • Anthem Silver Access Blue New England HMO 4000/10%/7250 w/HSA - 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
H70829MEDICARE UPIN (02) 

Medicare Participation & PECOS Enrollment Status

Thomas Johnson 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.

Thomas Johnson 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: 9335334200

    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: I20101117001029

    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.

Colonoscopy

A colonoscopy is a medical procedure that allows your doctor to examine your colon (the large intestine). It utilizes a thin, flexible tube with a tiny camera on the end, which is inserted through the rectum. This procedure can help identify issues such as polyps, inflammation, or early signs of cancer. It's usually recommended for people over 50 or those with specific risk factors.

This service was performed for 43 patients

Diagnostic exam of large bowel using a flexible endoscope

This procedure, known as a colonoscopy, involves using a flexible tube with a light and camera to examine the large intestine. It helps detect any abnormalities such as polyps or inflammation. It's a standard procedure to ensure gut health.

This service was performed 11 times for 11 patients

Established patient office or other outpatient visit, 10-19 minutes

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

This service was performed 49 times for 33 patients

Follow-up hospital inpatient care per day, typically 15 minutes

Follow-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 54 times for 31 patients

Hernia repair - groin (open)

Hernia repair in the groin area (open) is a surgical procedure to fix a bulge or protrusion, caused by internal tissues pushing through a weak spot in your abdominal wall. In this operation, a small incision is made in the groin area. The protruding tissue is then placed back into the abdomen, and the weakened area is reinforced with stitches or a mesh.

This service was performed for 1-10 patients

Hernia repair (minimally invasive)

Hernia repair is a surgery to fix a hernia - a condition where an organ pushes through an opening in the muscle or tissue that holds it in place. Minimally invasive hernia repair involves small incisions, a tiny camera, and special surgical tools. This method often leads to quicker recovery, less pain, and reduced scarring compared to traditional surgery.

This service was performed for 1-10 patients

Initial hospital inpatient care per day, typically 30 minutes

Initial hospital inpatient care refers to the first day of your stay in the hospital. This service typically includes a 30-minute check-up with a healthcare professional. They'll assess your health, discuss your condition, and plan your treatment. It's part of ensuring you receive the best possible care.

This service was performed 11 times for 11 patients

Initial hospital inpatient care per day, typically 50 minutes

Initial 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 38 times for 35 patients

Mastectomy

A mastectomy is a surgical procedure that involves the removal of all or part of the breast tissue. This is often done to treat or prevent conditions related to abnormal cell growth. There are different types, ranging from removing only the breast tissue to also removing nearby structures. The approach depends on individual health circumstances.

This service was performed for 1-10 patients

Melanoma (skin cancer) excision

Melanoma excision is a procedure where a surgeon removes melanoma, a type of skin cancer, and some surrounding healthy tissue. Local anesthesia is applied to numb the area. The goal is to completely remove the cancer and prevent its spread. Healing time varies.

This service was performed for 1-10 patients

New patient office or other outpatient visit, 15-29 minutes

This service involves an initial visit to the doctor's office or other outpatient setting. It typically lasts between 15-29 minutes. The doctor will review your medical history, conduct a physical examination, and discuss your health concerns. It's a chance to establish your health baseline and address any immediate medical issues.

This service was performed 31 times for 31 patients

Removal of polyps or growths of large bowel using an endoscope with mechanical snare

This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.

This service was performed 13 times for 12 patients

Upper gastrointestinal (GI) endoscopy for acid reflux

An upper GI endoscopy is a procedure to examine your esophagus and stomach using a thin, flexible tube called an endoscope. It helps diagnose conditions like acid reflux by identifying any inflammation or damage. It's generally safe, performed under sedation, and takes about 15-30 minutes.

This service was performed for 32 patients

Physician Visit Costs



The typical physician office visit costs for Medicare beneficiaries in this area are: $22.67 for a new patient copayment and $18.3 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 01550 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

  • Average New Patient Price $90.7
  • Minimum New Patient Price $58.86
  • Maximum New Patient Price $177.36
  • Average New Patient Copayment $22.67
  • Minimum New Patient Copayment $14.71
  • Maximum New Patient Copayment $44.34

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

  • Average Established Patient Price $73.22
  • Minimum Established Patient Price $19.11
  • Maximum Established Patient Price $144.84
  • Average Established Patient Copayment $18.3
  • Minimum Established Patient Copayment $4.77
  • Maximum Established Patient Copayment $36.21

* 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 90.62, 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: 90.62 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: 80.1

    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: 74.87

    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. Thomas Johnson is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
UMASS MEMORIAL HEALTH - HARRINGTON HOSPITAL100 SOUTH STREET
SOUTHBRIDGE, MA 01550
(508) 765-9771Acute 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.
1659476182
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
261098712116
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 6 + 1 + 0 + 9 + 8 + 7 + 1 + 2 + 1 + 1 + 6 + 24 = 68
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 68 = 22

The NPI number 1659476182 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 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1720089063DR. JOHN MICHAEL TUMOLO M.D.
Individual
Internal Medicine (Cardiovascular Disease)100 SOUTH ST SUITE 104
SOUTHBRIDGE, MA 01550
(508) 765-0636
1598759334DR. MARK J SIMONELLI M.D.
Individual
Obstetrics & Gynecology100 SOUTH ST SUITE G05
SOUTHBRIDGE, MA 01550
(508) 765-5981
1497741680 JILL ROBIN SISKIND APRN
Individual
Nurse Practitioner (Acute Care)100 SOUTH ST
SOUTHBRIDGE, MA 01550
(508) 765-9771
1740277813DR. CHRISTINE A CAREY M.D.
Individual
Obstetrics & Gynecology100 SOUTH ST SUITE G05
SOUTHBRIDGE, MA 01550
(508) 765-5981
1225029895DR. KATHLEEN MARY FINN D.O.
Individual
Emergency Medicine100 SOUTH ST
SOUTHBRIDGE, MA 01550
(508) 765-9771
1205819109DR. ELIAS BELEZOS M.D.
Individual
Internal Medicine100 SOUTH ST
SOUTHBRIDGE, MA 01550
(508) 765-9771
1750350575 PRAVEEN B GULATI MD
Individual
Radiology (Nuclear Radiology)100 SOUTH ST
SOUTHBRIDGE, MA 01550
(508) 765-9771
1972572329 ABHIJIT ROYCHOWDHURY MD
Individual
Radiology (Nuclear Radiology)100 SOUTH ST
SOUTHBRIDGE, MA 01550
(508) 765-9771
1235193889 ROBERT J GIORDANO MD
Individual
Pediatrics (Adolescent Medicine)100 SOUTH ST SUITE 205
SOUTHBRIDGE, MA 01550
(508) 765-0934
1972568061DR. MICHAEL P. GAUDET M.D.
Individual
Emergency Medicine100 SOUTH ST
SOUTHBRIDGE, MA 01550
(508) 765-9771
1528026622DR. ISSAM A ONEYSSI M.D.
Individual
Internal Medicine100 SOUTH ST
SOUTHBRIDGE, MA 01550
(508) 765-9771
1891739900DR. PAMELA ANNE WILSON D.O. FACOP
Individual
Pediatrics100 SOUTH ST MEDICAL ARTS BUILDING, STE 207
SOUTHBRIDGE, MA 01550
(508) 765-9700
1043246978DR. WILLIAM FRANCIS DUNN D.O.
Individual
Internal Medicine100 SOUTH ST SUITE G08
SOUTHBRIDGE, MA 01550
(508) 764-2620
1265469076DR. DONALD JOSEPH GENTILE
Individual
Specialist100 SOUTH ST MEDICAL ARTS BUILDING SUITE 208
SOUTHBRIDGE, MA 01550
(508) 764-6356
1043240070 CAITLIN ANN MELIA RD
Individual
Dietitian, Registered100 SOUTH ST HARRINGTON HOSPITAL
SOUTHBRIDGE, MA 01550
(508) 765-9771
1891713160 ALAN RICHARD ANDERSON C.R.N.A.
Individual
Nurse Anesthetist, Certified Registered100 SOUTH ST
SOUTHBRIDGE, MA 01550
(508) 765-9771
1447264270 KEITH R HILLIKER MD
Individual
Emergency Medicine (Emergency Medical Services)100 SOUTH ST
SOUTHBRIDGE, MA 01550
(508) 765-9771
1013923101DR. CARL JOHN VANDERPUTTEN DO
Individual
Emergency Medicine100 SOUTH ST HARRINGTON MEMORIAL HOSPITAL
SOUTHBRIDGE, MA 01550
(508) 765-9771
1366458457MS. CYNTHIA MAE WILSON GRILLO DO
Individual
Pediatrics100 SOUTH ST SUITE 102
SOUTHBRIDGE, MA 01550
(508) 764-3194
1730196205 ARTHUR ROBERT RUSSO MD
Individual
Internal Medicine100 SOUTH ST
SOUTHBRIDGE, MA 01550
(508) 765-9771

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1659476182, enumerated in the NPI registry as an "individual" on September 13, 2006

The provider is located at 100 South St Suite 108 Southbridge, Ma 01550 and the phone number is (508) 764-6966

The provider's speciality is Surgery with taxonomy code 208600000X

The provider has more than 30 years of experience. He graduated from Medical College Of Pennsylvania in 1996.

The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield, 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.

Medicare beneficiaries should expect a typical cost of $90.7 with an average copayment of $22.67 for new patient appointments. Established patients should expect a typical charge of $73.22 and an average copayment of 18.3. 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: Colonoscopy, Diagnostic exam of large bowel using a flexible endoscope, Established patient office or other outpatient visit, 10-19 minutes, Follow-up hospital inpatient care per day, typically 15 minutes, Hernia repair - groin (open), Hernia repair (minimally invasive), Initial hospital inpatient care per day, typically 30 minutes, Initial hospital inpatient care per day, typically 50 minutes, Mastectomy, Melanoma (skin cancer) excision, New patient office or other outpatient visit, 15-29 minutes, Removal of polyps or growths of large bowel using an endoscope with mechanical snare and Upper gastrointestinal (GI) endoscopy for acid reflux.

The practitioner is affiliated to the following hospital(s): UMASS MEMORIAL HEALTH - HARRINGTON 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 September 13, 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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