DR. CRAIG GERSTENKORN M.D.
NPI 1801835160
Emergency Medicine in San Antonio, TX
Quality Rating: 98.01 out of 100 score
NPI Status: Active since June 05, 2006
Contact Information
8401 DATAPOINT DR
SUITE 500
SAN ANTONIO, TX
ZIP 78229
Phone: (210) 614-0180
Fax: (210) 615-7170
- Individual
- Male
- Emergency Medicine
- Accepts Insurance
- PECOS Enrolled
- Medicare Quality Reporting
About CRAIG GERSTENKORN
This page provides the complete NPI Profile along with additional information for Craig Gerstenkorn, a provider established in San Antonio, Texas with a medical specialization in Emergency Medicine. The healthcare provider is registered in the NPI registry with number 1801835160 assigned on June 2006. The practitioner's primary taxonomy code is 207P00000X with license number J3479 (TX). The provider is registered as an individual and his NPI record was last updated 14 years ago.
- NPI
- 1801835160
- Provider Name
- DR. CRAIG GERSTENKORN M.D.
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 8401 DATAPOINT DR SUITE 500 SAN ANTONIO, TX 78229
- Location Phone
- (210) 614-0180
- Location Fax
- (210) 615-7170
- Mailing Address
- 8401 DATAPOINT DR SUITE 500 SAN ANTONIO, TX 78229
- Mailing Phone
- (210) 614-0180
- Mailing Fax
- (210) 615-7170
- Is Sole Proprietor?
- No
- Enumeration Date
- 06-05-2006
- Last Update Date
- 03-09-2011
- Code Navigator
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
Emergency Medicine
- Taxonomy Code
- 207P00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- J3479
- License State
- TX
- Taxonomy Description
- An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Gold 10 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + Adult Dental + Vision - HMO
- Gold 10: $0 PCP at Aetna network & MinuteClinic Primary Care + $0 CVS Health Virtual Care - HMO
- Gold 3 Advanced: Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 - HMO
- Gold 3 Advanced: Aetna network + $0 walk-in clinic + Adult Dental + Vision - HMO
- Gold 4 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 - HMO
- Gold S: Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 - HMO
- Silver 10 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 - HMO
- Silver 10 Advanced: $0 PCP + Aetna network + $0 walk-in clinic + Adult Dental + Vision - HMO
- Silver 10: $0 PCP at Aetna network & MinuteClinic Primary Care + $0 CVS Health Virtual Care - HMO
- Silver 5 Advanced: Aetna network + $0 walk-in clinic + $0 CVS Health Virtual Care 24/7 - HMO
- 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
- Gold 1 - HMO
- Gold 1 with Adult Vision Services - HMO
- Gold 12 - HMO
- Gold 8 - HMO
- Silver 1 - HMO
- Silver 1 with Adult Vision Services - HMO
- Silver 12 with First 4 Primary Care Visits Free - HMO
- Silver 8 - 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.
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 |
|---|---|---|---|
| E90382 | MEDICARE UPIN (02) | TX | |
| 86693J | MEDICARE PIN (08) | TX | |
| 86693J | OTHER (01) | TX | BCBS |
| 930093757 | MEDICARE PIN (08) | TX | |
| 115306601 | MEDICAID (05) | TX |
Medicare Participation & PECOS Enrollment Status
Craig Gerstenkorn 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.
Emergency department visit for life threatening or functioning severity
Emergency department visit for problem of high severity
Emergency department visit for problem of moderate severity
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only
An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.
This service was performed 90 times for 77 patientsAn emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.
This service was performed 55 times for 41 patientsAn emergency department visit for a problem of moderate severity involves immediate medical attention for issues like minor fractures, burns, or high fever. The healthcare team will assess your condition, provide necessary treatment, and may suggest further tests or admission if required.
This service was performed 30 times for 30 patientsA routine electrocardiogram (ECG) with 12 leads is a simple, non-invasive test that records the electrical activity of your heart. It helps in identifying heart conditions by detecting irregularities in your heart rhythms. The results are interpreted and a report is provided.
This service was performed 56 times for 52 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 78229 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $84.92
- Minimum New Patient Price $54.84
- Maximum New Patient Price $166.88
- Average New Patient Copayment $21.23
- 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 99214
- Average Established Patient Price $97.05
- Minimum Established Patient Price $17.52
- Maximum Established Patient Price $136.11
- Average Established Patient Copayment $24.26
- 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 98.01, 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.
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Final Score: 98.01 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.
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Quality Score: 91.78
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.
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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.
Quality Reporting
The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Implementation of an ASP | Yes | N/A |
| Change Activity Description to: Leadership of an Antimicrobial Stewardship Program (ASP) that includes implementation of an ASP that measures the appropriate use of antibiotics for several different conditions (such as but not limited to upper respiratory infection treatment in children, diagnosis of pharyngitis, bronchitis treatment in adults) according to clinical guidelines for diagnostics and therapeutics. Specific activities may include: • Develop facility-specific antibiogram and prepare report of findings with specific action plan that aligns with overall facility or practice strategic plan. • Lead the development, implementation, and monitoring of patient care and patient safety protocols for the delivery of ASP including protocols pertaining to the most appropriate setting for such services (i.e., outpatient or inpatient). • Assist in improving ASP service line efficiency and effectiveness by evaluating and recommending improvements in the management structure and workflow of ASP processes. • Manage compliance of the ASP policies and assist with implementation of corrective actions in accordance with facility or clinic compliance policies and hospital medical staff by-laws. • Lead the education and training of professional support staff for the purpose of maintaining an efficient and effective ASP. • Coordinate communications between ASP management and facility or practice personnel regarding activities, services, and operational/clinical protocols to achieve overall compliance and understanding of the ASP. • Assist, at the request of the facility or practice, in preparing for and responding to third-party requests, including but not limited to payer audits, governmental inquiries, and professional inquiries that pertain to the ASP service line. • Implementing and tracking an evidence-based policy or practice aimed at improving antibiotic prescribing practices for high-priority conditions. • Developing and implementing evidence-based protocols and decision-support for diagnosis and treatment of common infections. • Implementing evidence-based protocols that align with recommendations in the Centers for Disease Control and Prevention’s Core Elements of Outpatient Antibiotic Stewardship guidance | ||
| Implementation of formal quality improvement methods, practice changes, or other practice improvement processes | Yes | N/A |
| Adopt a formal model for quality improvement and create a culture in which all staff actively participates in improvement activities that could include one or more of the following such as: • Multi-Source Feedback; • Train all staff in quality improvement methods; • Integrate practice change/quality improvement into staff duties; • Engage all staff in identifying and testing practices changes; • Designate regular team meetings to review data and plan improvement cycles; • Promote transparency and accelerate improvement by sharing practice level and panel level quality of care, patient experience and utilization data with staff; and/or • Promote transparency and engage patients and families by sharing practice level quality of care, patient experience and utilization data with patients and families, including activities in which clinicians act upon patient experience data. | ||
| Measurement and Improvement at the Practice and Panel Level | Yes | N/A |
| Measure and improve quality at the practice and panel level, such as the American Board of Orthopaedic Surgery (ABOS) Physician Scorecards, that could include one or more of the following: • Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice level and at the level of the care team or MIPS eligible clinician or group (panel); and/or • Use relevant data sources to create benchmarks and goals for performance at the practice level and panel level. | ||
| Participation in an AHRQ-listed patient safety organization. | Yes | N/A |
| Participation in an AHRQ-listed patient safety organization. | ||
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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. | |||||||||
| 1 | 8 | 0 | 1 | 8 | 3 | 5 | 1 | 6 | 0 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 8 | 0 | 1 | 16 | 3 | 10 | 1 | 12 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 8 + 0 + 1 + 1 + 6 + 3 + 1 + 0 + 1 + 1 + 2 + 24 = 50 | |||||||||
| Step 3: because the number obtained in step 2 ends in zero, the check digit is zero. | |||||||||
| 0 | |||||||||
The NPI number 1801835160 is valid because the calculated check digit 0 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 |
|---|---|---|---|
| 1609878529 | DR. EDWARD SARGENT MD Individual | Internal Medicine | 8401 DATAPOINT DR #401 SAN ANTONIO, TX 78229 (210) 949-2200 |
| 1558356600 | ROBERT W KOTTMAN MD Individual | Emergency Medicine | 8401 DATAPOINT DR SUITE 500 SAN ANTONIO, TX 78229 (210) 614-0180 |
| 1497742647 | DR. DALE D DUBOIS MD Individual | Emergency Medicine (Pediatric Emergency Medicine) | 8401 DATAPOINT DR STE 500 SAN ANTONIO, TX 78229 (210) 614-0180 |
| 1427021468 | RANDALL H SCHUSTER M.D. Individual | Emergency Medicine | 8401 DATAPOINT DR SUITE 500 SAN ANTONIO, TX 78229 (210) 614-0180 |
| 1588638720 | DR. KENDALL WILLIAM STYSKAL M.D. Individual | Emergency Medicine | 8401 DATAPOINT DR SUITE 500 SAN ANTONIO, TX 78229 (210) 614-0180 |
| 1376518639 | DR. VICTOR BURGOS M.D. Individual | Emergency Medicine | 8401 DATAPOINT DR SUITE 500 SAN ANTONIO, TX 78229 (210) 614-0180 |
| 1972578714 | DR. RICHARD S CHUANG M.D. Individual | Emergency Medicine | 8401 DATAPOINT DR SUITE 500 SAN ANTONIO, TX 78229 (210) 614-0180 |
| 1073589917 | DR. HAROLD M. BRANNAN M.D. Individual | Radiology (Diagnostic Radiology) | 8401 DATAPOINT DR SUITE 600 SAN ANTONIO, TX 78229 (210) 616-7700 |
| 1164498135 | DR. ANDREA L. ALLRED-CROUCH M.D. Individual | Radiology (Diagnostic Radiology) | 8401 DATAPOINT DR SUITE 600 SAN ANTONIO, TX 78229 (210) 616-7700 |
| 1225005978 | DR. JOSEPH P. MILLER M.D. Individual | Radiology (Diagnostic Radiology) | 8401 DATAPOINT DR SUITE 600 SAN ANTONIO, TX 78229 (210) 616-7700 |
| 1396712048 | DR. ROSA E. RAMIREZ M.D. Individual | Radiology (Diagnostic Radiology) | 8401 DATAPOINT DR SUITE 600 SAN ANTONIO, TX 78229 (210) 616-7700 |
| 1013984764 | DR. GLADYS S. SEPULVEDA M.D. Individual | Radiology (Diagnostic Radiology) | 8401 DATAPOINT DR SUITE 600 SAN ANTONIO, TX 78229 (210) 616-7700 |
| 1871560565 | DR. ROBERT V. KNAPP M.D. Individual | Radiology (Diagnostic Radiology) | 8401 DATAPOINT DR SUITE 600 SAN ANTONIO, TX 78229 (210) 616-7700 |
| 1295702983 | DR. JOSEPH R. MCCOLLEY M.D. Individual | Radiology (Diagnostic Radiology) | 8401 DATAPOINT DR SUITE 600 SAN ANTONIO, TX 78229 (210) 616-7700 |
| 1912974346 | DR. WILLIAM J. SHEA JR. M.D. Individual | Radiology (Diagnostic Radiology) | 8401 DATAPOINT DR SUITE 600 SAN ANTONIO, TX 78229 (210) 616-7700 |
| 1659348977 | DR. ROBERT E. VASQUEZ M.D. Individual | Radiology (Diagnostic Radiology) | 8401 DATAPOINT DR SUITE 600 SAN ANTONIO, TX 78229 (210) 616-7700 |
| 1902873201 | DAVID C RIOJAS MD Individual | Emergency Medicine (Pediatric Emergency Medicine) | 8401 DATAPOINT DR SUITE 500 SAN ANTONIO, TX 78229 (210) 614-0180 |
| 1467429696 | DR. JOHN B. KAMP M.D. Individual | Radiology (Diagnostic Radiology) | 8401 DATAPOINT DR SUITE 600 SAN ANTONIO, TX 78229 (210) 616-7700 |
| 1881662757 | MRS. STEPHANIE M. PHILIPP PAC Individual | Physician Assistant | 8401 DATAPOINT DR SUITE 500 SAN ANTONIO, TX 78229 (210) 614-0180 |
| 1174583892 | MR. JOHN CURRAN PA Individual | Physician Assistant | 8401 DATAPOINT DR SUITE 500 SAN ANTONIO, TX 78229 (210) 614-0180 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1801835160, enumerated in the NPI registry as an "individual" on June 05, 2006
The provider is located at 8401 Datapoint Dr Suite 500 San Antonio, Tx 78229 and the phone number is (210) 614-0180
The provider's speciality is Emergency Medicine with taxonomy code 207P00000X
The provider might be accepting Accepts: Aetna CVS Health, Blue Cross and Blue Shield of. 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 $84.92 with an average copayment of $21.23 for new patient appointments. Established patients should expect a typical charge of $97.05 and an average copayment of 24.26. 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: Emergency department visit for life threatening or functioning severity, Emergency department visit for problem of high severity, Emergency department visit for problem of moderate severity and Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only.
This NPI record was last updated on June 05, 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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