Melissa James , PA-C

Medicare-allowed amount

About $1,396 in 2020

The total amount Medicare approved for these services in 2020. It includes what Medicare paid and what patients or their other insurance owed, such as the deductible and coinsurance.

It shows the total cost of this clinician's Original Medicare services under Medicare's fee rules.

Source: CMS, Medicare Physician & Other Practitioners – by Provider and Service, 2020.

Paid by Medicare

About $946 in 2020

The part of the Medicare-allowed amount that Medicare itself paid in 2020, after patients' deductibles and coinsurance.

The gap between the allowed amount and this number is roughly what patients and their other insurance paid.

Source: CMS, Medicare Physician & Other Practitioners – by Provider and Service, 2020.

Years since graduation

14 years (graduated 2012)

CMS Doctors and Clinicians data list 2012 as the year this clinician finished professional school.

It tells you roughly how long ago the clinician finished school.

Source: CMS Doctors and Clinicians National Downloadable File.

NPI first issued

2012

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

Source: CMS NPPES NPI Registry.

Accepts Medicare assignment

CMS data list this clinician as accepting Medicare assignment. This means agreeing to take the Medicare-approved amount as full payment for covered services.

With Original Medicare, you usually pay only your deductible and coinsurance, and the office sends the claim to Medicare for you.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, “Does your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Enrolled in Medicare (PECOS)

Melissa James has a Medicare enrollment record in PECOS, the CMS system clinicians use to enroll so they can bill Medicare or order services for people with Medicare.

It does not show whether the clinician accepts assignment, is in your plan's network, or is taking new patients.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What Medicare enrollment (PECOS) means

Can order Medicare-covered services

CMS lists Melissa James as eligible to order or refer Medicare Part B clinical laboratory and imaging services, durable medical equipment (DME) and home health services for people with Medicare.

Medicare pays for these items and services only when they are ordered by an eligible clinician.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What ordering and referring status means