STEPHEN B. WILES MD
NPI 1932136959
Ophthalmology in Kansas City, MO

Medicare Participation & PECOS Enrollment Status

Stephen Wiles 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.

Stephen Wiles 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: 1355345752

  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: I20090728000364

  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.

Cataract surgery

Cataract surgery is a procedure to remove the lens of your eye when it becomes cloudy, which is called a cataract. A synthetic lens is then inserted to restore clear vision. The operation is typically done on an outpatient basis and is very safe and effective.

This service was performed for 792 patients

Complex removal of cataract with insertion of prosthetic lens

This procedure involves removing a cloudy lens (cataract) from your eye and replacing it with a clear, artificial lens. It helps restore vision that has been affected by the cataract. The operation is usually done under local anesthesia.

This service was performed 13 times for 11 patients

Creation of eye fluid drainage tracts in iris using a laser, per session

This procedure uses a laser to create small drainage tracts in the iris, the colored part of your eye. This helps excess fluid escape, reducing pressure in the eye that can cause glaucoma. It's performed in sessions.

This service was performed 29 times for 15 patients

Established patient complete exam of visual system

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 2,039 times for 1,370 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 1,003 times for 669 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 134 times for 127 patients

Established patient problem focused exam of visual system

This 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 18 times for 18 patients

Exam of retinal blood vessels and blood vessels between the white part of eye and retina using a special camera after injection of a dye

This procedure involves a special camera capturing images of the eye's blood vessels. A dye is injected into your body, which travels to the eye's vessels, highlighting them in the photos. This helps identify any abnormalities in the retina and surrounding areas.

This service was performed 651 times for 286 patients

Exam of retinal blood vessels using a special camera after injection of a dye

This procedure, known as a fluorescein angiography, involves taking images of the back of your eye. A dye is injected into your arm that travels to your eye, highlighting the blood vessels in your retina. This helps identify any abnormalities.

This service was performed 412 times for 279 patients

Exam of the internal drainage system of eye

This 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 142 times for 141 patients

Exam of visual field with extended testing

An 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 1,086 times for 731 patients

Exam of visual field with limited testing

An exam of the visual field with limited testing is a quick check of your peripheral vision. It involves identifying objects or movements at the edge of your sight, helping to detect any vision loss that isn't obvious, such as blind spots or areas of reduced vision.

This service was performed 41 times for 41 patients

Extracapsular removal of cataract with insertion of artificial lens and insertion of drainage device in front chamber of eye

This is a two-part eye procedure. First, a cloudy lens (cataract) is removed from its outer layer and replaced with an artificial lens to improve vision. Second, a drainage device is inserted into the front part of the eye to manage fluid levels, preventing pressure build-up.

This service was performed 30 times for 16 patients

Imaging of front third of eye

Imaging of the front third of the eye, also known as anterior segment imaging, captures detailed images of the eye's front part. This includes the iris, cornea, and lens. It's a non-invasive procedure that helps diagnose and monitor eye conditions.

This service was performed 14 times for 14 patients

Imaging of front third of eye using a special microscope

This procedure involves capturing detailed images of the front part of your eye using a specialized microscope. It helps in identifying any eye abnormalities or issues, improving the accuracy of diagnosis and treatment planning.

This service was performed 312 times for 311 patients

Imaging of optic nerve

Imaging 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 1,031 times for 702 patients

Imaging of retina

Imaging of the retina is a non-invasive procedure that captures detailed images of your eye's interior. This helps detect conditions like macular degeneration or retinal detachment. It's painless and takes only a few minutes.

This service was performed 2,487 times for 740 patients

Incision to improve eye fluid flow

This procedure, known as a trabeculectomy, involves creating a small opening in the eye to improve fluid flow. This can help lower eye pressure in conditions like glaucoma. It's a common, safe procedure to protect your eye health.

This service was performed 24 times for 16 patients

Injection of drug into eye

An injection into the eye is a procedure where a medication is delivered directly into your eye to treat various conditions. A local anesthetic is applied to numb the eye, ensuring minimal discomfort. The drug helps manage diseases like macular degeneration or diabetic retinopathy.

This service was performed 2,934 times for 329 patients

Injection of medication into eye

This procedure involves administering medication directly into your eye. A tiny needle is used to deliver the drug into the vitreous, a jelly-like substance in the eye. It helps treat conditions like macular degeneration or diabetic retinopathy. It's generally safe and effective.

This service was performed 160 times for 106 patients

Injection of medication into space above choroid membrane of eye

This procedure involves injecting medication into the space above the choroid membrane in your eye. It's usually done to treat certain eye conditions. A specialist uses a thin needle to deliver the medicine. You may feel slight discomfort, but it's generally well-tolerated.

This service was performed 36 times for 28 patients

Injection, aflibercept, 1 mg

Aflibercept injection is a treatment for certain eye conditions that affect vision. It works by blocking abnormal blood vessel growth and leakage in the eye, which can cause vision loss. The medication is administered directly into the eye by a healthcare professional.

This service was performed 168 times for 14 patients

Injection, faricimab-svoa, 0.1 mg

Faricimab-svoa is a medication given through an injection into the eye to treat certain eye conditions. The 0.1 mg dosage helps control disease progression, improving vision and eye health. The procedure is done by a healthcare professional.

This service was performed 8,820 times for 54 patients

Injection, ranibizumab, 0.1 mg

Ranibizumab is a medication given via injection to treat certain eye conditions like age-related macular degeneration. It works by slowing vision loss and in some cases, improving vision by blocking abnormal blood vessel growth in the eye.

This service was performed 10,854 times for 284 patients

Insertion of drug delivery implant into tear duct of eye

This procedure involves placing a small implant into your tear duct. The implant slowly releases medication to your eye, helping manage conditions like dry eyes or glaucoma. It's a simple, quick procedure typically performed under local anesthesia.

This service was performed 49 times for 32 patients

Insertion of eye fluid drainage device

The insertion of an eye fluid drainage device is a procedure to manage eye pressure. A small device is placed in the eye to help drain excess fluid, reducing pressure that can damage the optic nerve and lead to vision loss. This procedure is often used for glaucoma treatment.

This service was performed 27 times for 24 patients

Laser repair to improve eye fluid flow

Laser repair to improve eye fluid flow is a procedure aimed at treating glaucoma. A laser is used to create a small hole in the eye's drainage system, allowing fluid to flow out more easily. This helps to lower the pressure inside the eye, reducing the risk of vision loss.

This service was performed 52 times for 34 patients

Measurement of corneal curvature and depth of eye

This procedure measures the shape and depth of your eye, specifically the cornea, the clear front surface. It helps in diagnosing conditions, planning for surgeries, or fitting contact lenses. It's non-invasive and painless.

This service was performed 96 times for 63 patients

Microfluid analysis of tears

Microfluid analysis of tears involves collecting a small tear sample to examine its composition. This procedure can help detect health issues like dry eye disease, inflammation, or other eye conditions. It's a non-invasive, painless method for monitoring eye health.

This service was performed 2,120 times for 789 patients

New patient complete exam of visual system

A 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 104 times for 104 patients

New patient office or other outpatient visit, 45-59 minutes

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

This service was performed 111 times for 111 patients

Photography of content of eyes

Photography 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 131 times for 129 patients

Photography of the retina

Photography 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 1,445 times for 1,003 patients

Removal of cataract with insertion of prosthetic lens

This is a procedure where a cloudy lens in your eye, known as a cataract, is removed. After removal, a clear artificial lens is inserted. This helps to restore your vision, enabling you to see clearly again.

This service was performed 255 times for 147 patients

Removal of excessive skin and fat of upper eyelid

This procedure, also known as upper eyelid surgery, is performed to remove excess skin and fat from the upper eyelid. It can help improve vision if heavy eyelids hinder it, and can also enhance the appearance of the eyes. It's a common, safe procedure.

This service was performed 16 times for 16 patients

Removal of eyelashes using forceps

The removal of eyelashes using forceps is a simple procedure where a medical professional gently extracts unwanted or problematic eyelashes with a specialized tool. This is often done to alleviate discomfort or to treat conditions like trichiasis, where eyelashes grow inward.

This service was performed 13 times for 11 patients

Removal of recurring cataract in lens capsule using a laser

This 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 254 times for 157 patients

Repair of tendon of upper eyelid

Repair of the tendon of the upper eyelid is a surgical procedure aimed at fixing a droopy eyelid. This condition can affect your vision and appearance. The procedure involves tightening the tendon to lift the eyelid to its normal position, improving both function and aesthetics.

This service was performed 11 times for 11 patients

Ultrasound scan of cornea to determine thickness

An 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 345 times for 343 patients

Ultrasound scan to determine eye length and lens power

An ultrasound scan for the eye is a safe, non-invasive procedure. It uses sound waves to create images of your eye's structure. This helps determine the length of your eye and the power of your lens, which is crucial for diagnosing eye conditions and planning surgeries.

This service was performed 208 times for 126 patients

Unclassified biologics

Unclassified biologics are a type of treatment derived from living organisms. They can include a wide range of substances, such as vaccines, blood components, or genes, used to prevent or treat diseases. Each is specifically designed to interact with the body's natural defenses to promote healing.

This service was performed 161 times for 29 patients

Unclassified drugs

Unclassified drugs are medications that don't fit into an existing category or class due to their unique properties or uses. They may be used for various conditions and their effects may differ widely. Always ask your healthcare provider for more information about these drugs.

This service was performed 188 times for 63 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $31.9 for a new patient copayment and $17.27 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 64118 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 81.37, 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: 81.37 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: 100

  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: 37.9

  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: 37.9

  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.

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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 1932136959 is valid because the calculated check digit 9 using the Luhn validation algorithm matches the last digit of the original NPI number.

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