DR. PRABHAVATHI GUMMALLA M.D
NPI 1750700852
Pediatrics - Pediatric Pulmonology in Philadelphia, PA

Medicare Participation & PECOS Enrollment Status

Prabhavathi Gummalla 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.

Prabhavathi Gummalla 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: 9931432663

  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: I20230328001137

  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-Other DME (DE001N)

  Tubing with integrated heating element for use with positive airway pressure device (HCPCS:A4604)

  1 DME suppliers used 16 Medicare Claims 16 Services Paid

• DME-Other DME (DE001N)

  Cushion for use on nasal mask interface, replacement only, each (HCPCS:A7032)

  1 DME suppliers used 17 Medicare Claims 102 Services Paid

• DME-Other DME (DE001N)

  Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap (HCPCS:A7034)

  1 DME suppliers used 22 Medicare Claims 22 Services Paid

• DME-Other DME (DE001N)

  Headgear used with positive airway pressure device (HCPCS:A7035)

  1 DME suppliers used 11 Medicare Claims 11 Services Paid

• DME-Other DME (DE001N)

  Filter, disposable, used with positive airway pressure device (HCPCS:A7038)

  1 DME suppliers used 18 Medicare Claims 108 Services Paid

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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 1750700852 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.

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Frequently Asked Questions