DR. BRIAN J. COLE M.D.
NPI 1659350379
Orthopaedic Surgery - Sports Medicine in Chicago, IL
NPI Status: Active since January 11, 2006
Contact Information
1611 W HARRISON ST
STE 400
CHICAGO, IL
ZIP 60612
Phone: (312) 243-4244
Fax: (312) 243-2744
- Individual
- Male
- Years of Experience 34
- Orthopaedic Surgery
- Sports Medicine
- PECOS Enrolled
- Accepts Medicare Approved Payment
- Medicare Quality Reporting
About BRIAN COLE
Brian Cole is a provider established in Chicago, Illinois and his medical specialization is Orthopaedic Surgery with a focus in sports medicine with more than 34 years of experience. The healthcare provider is registered in the NPI registry with number 1659350379 assigned on January 2006. The practitioner's primary taxonomy code is 207XX0005X with license number 036095694 (IL). The provider is registered as an individual and his NPI record was last updated one year ago.
- NPI
- 1659350379
- Provider Name
- DR. BRIAN J. COLE M.D.
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 1611 W HARRISON ST STE 400 CHICAGO, IL 60612
- Location Phone
- (312) 243-4244
- Location Fax
- (312) 243-2744
- Mailing Address
- 1 WESTBROOK CORPORATE CTR #240 WESTCHESTER, IL 60154
- Medical School Name
- OTHER
- Graduation Year
- 1990
- Is Sole Proprietor?
- No
- Enumeration Date
- 01-11-2006
- Last Update Date
- 03-01-2023
- Code Navigator
Brian Cole 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.
The provider participated in CMS Quality Payment Program and the following quality measures were reported: . The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries.
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
Orthopaedic Surgery Sports Medicine
- Taxonomy Code
- 207XX0005X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 036095694
- License State
- IL
- Taxonomy Description
- An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Aetna CVS Health
- Bronze 1 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay - PPO
- Bronze 1: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 + Rx Copay - HMO
- Bronze 4 PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care - PPO
- Bronze 4: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
- Bronze S PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care - PPO
- Bronze S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
- Gold 3 PPO: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care + Rx Copay - PPO
- Gold 3: Aetna network of doctors + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 + Rx Copay - HMO
- Gold S PPO: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care - PPO
- Gold S: Aetna network of doctors & hospitals + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - HMO
Blue Cross and Blue Shield of Illinois
- Blue Choice Preferred Bronze PPO℠ 201 - PPO
- Blue Choice Preferred Bronze PPO℠ 202 - PPO
- Blue Choice Preferred Bronze PPO℠ 601 - Rx Copays - PPO
- Blue Choice Preferred Bronze PPO℠ 701 - Rx Copays - PPO
- Blue Choice Preferred Bronze PPO℠ 708 - PPO
- Blue Choice Preferred Gold PPO℠ 204 - Rx Copays - PPO
- Blue Choice Preferred Gold PPO℠ 707 - PPO
- Blue Choice Preferred Security PPO℠ 200 - PPO
- Blue Choice Preferred Silver PPO℠ 203 - PPO
- Blue Choice Preferred Silver PPO℠ 706 - PPO
Molina Healthcare
- Gold 1 - HMO
- Gold 1 with Adult Vision Services - HMO
- Gold 8 with Rx Copay - HMO
- Silver 1 - HMO
- Silver 1 with Rx Copay and Adult Vision Services - HMO
- Silver 12 with first 4 free PCP or MH visits - HMO
- Silver 8 - HMO
Medicare
Medicaid
Aetna
Railroad Medicare
Blue Cross Blue Shield
*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 |
---|---|---|---|
207073 | OTHER (01) | IL | MEDICARE PTAN LOCALITY 15 |
5908567 | OTHER (01) | AETNA | |
DA4902 | OTHER (01) | RAILROAD MEDICARE PTAN | |
036095694 | MEDICAID (05) | IL | |
207067 | OTHER (01) | IL | MEDICARE PTAN LOCALITY 16 |
1633878 | OTHER (01) | IL | BCBS |
P00072972 | OTHER (01) | RAILROAD MEDICARE |
PECOS Enrollment and Medicare Participation Status
Brian Cole 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: 6901719863
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: I20101011000628, I20190314000030
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.
Prosthetic and Orthotic Devices
Prosthetic/Orthotic devices (D1F)
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf (HCPCS:L3670)
3 DME suppliers used 36 Medicare Claims 36 Services Paid
Quality Reporting
The following quality measures meet Medicare's statistical reporting standards for the year 2018. 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 |
---|
Clinician Services
The following Healthcare Common Procedure Coding System (HCPCS) codes were publicly reported as the top services rendered by this provider under the Medicare program for the year 2020. The reported codes are based on the top 5 codes for each available specialty, excluding evaluation and management codes.
- 119
X-ray of shoulder, minimum of 2 views (HCPCS:73030)
- 117
X-ray of knee, 4 or more views (HCPCS:73564)
- 112
Aspiration and/or injection of large joint or joint capsule (HCPCS:20610)
- 93
X-ray of knee, 3 views (HCPCS:73562)
- 16
X-ray of hip with pelvis, 2-3 views (HCPCS:73502)
Hospital Affiliations
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. Brian Cole is affiliated with the following medical facilities:
Hospital Name | Address | Phone | Hospital Type | Overall Rating |
---|---|---|---|---|
RUSH OAK PARK HOSPITAL | 520 S MAPLE AVE OAK PARK, IL 60304 | (708) 383-9300 | Acute Care Hospitals | |
SILVER CROSS HOSPITAL AND MEDICAL CENTERS | 1900 SILVER CROSS BLVD NEW LENOX, IL 60451 | (815) 300-1100 | Acute Care Hospitals |
Reviews for DR. BRIAN J. COLE M.D.
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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 | 6 | 5 | 9 | 3 | 5 | 0 | 3 | 7 | 9 |
Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
2 | 6 | 10 | 9 | 6 | 5 | 0 | 3 | 14 | |
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
2 + 6 + 1 + 0 + 9 + 6 + 5 + 0 + 3 + 1 + 4 + 24 = 61 | |||||||||
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
70 - 61 = 9 | 9 |
The NPI number 1659350379 is valid because the calculated check digit 9 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 |
---|---|---|---|
1235138546 | DR. THOMAS J NIELSEN M.D. Individual | Otolaryngology | 1611 W HARRISON ST SUITE 550 CHICAGO, IL 60612 (312) 942-6100 |
1154309110 | GUNNAR B.J. ANDERSSON MD Individual | Orthopaedic Surgery | 1611 W HARRISON ST STE 400 CHICAGO, IL 60612 (312) 243-4244 |
1982683694 | DR. RICHARD A BERGER M.D. Individual | Orthopaedic Surgery | 1611 W HARRISON ST STE 400 CHICAGO, IL 60612 (312) 243-4244 |
1275512964 | DR. AARON G ROSENBERG M.D. Individual | Orthopaedic Surgery | 1611 W HARRISON ST STE 400 CHICAGO, IL 60612 (312) 243-4244 |
1811964679 | DR. DAVID FAVREAU FARDON M.D. Individual | Orthopaedic Surgery | 1611 W HARRISON ST STE 400 CHICAGO, IL 60612 (312) 243-4244 |
1467406512 | STACY TWIGG P.A. Individual | Physician Assistant (Surgical) | 1611 W HARRISON ST STE 400 CHICAGO, IL 60612 (312) 243-4244 |
1710934062 | JOCELYN A. SHOOK P.A. Individual | Physician Assistant (Surgical) | 1611 W HARRISON ST STE 400 CHICAGO, IL 60612 (312) 243-4244 |
1629025978 | LAUREN E MAZUR PA-C Individual | Physician Assistant (Surgical) | 1611 W HARRISON ST STE 400 CHICAGO, IL 60612 (312) 243-4244 |
1144245994 | SCOTT B PALMER MD Individual | Internal Medicine | 1611 W HARRISON ST SUITE 212 CHICAGO, IL 60612 (312) 942-4040 |
1184630923 | MS. MARIA TROGRANCIC FERRO PA-C Individual | Physician Assistant (Surgical) | 1611 W HARRISON ST SUITE 400 CHICAGO, IL 60612 (312) 243-4244 |
1720177017 | NATALIE J. PODBOY PA-C Individual | Physician Assistant (Surgical) | 1611 W HARRISON ST STE 400 CHICAGO, IL 60612 (312) 243-4244 |
1124101548 | RUSH OTOLARYNGOLOGY HEAD AND NECK SURGERY Organization | Otolaryngology | 1611 W HARRISON ST SUITE 550 CHICAGO, IL 60612 (312) 942-6100 |
1801954490 | ALLISON TERRY PA-C Individual | Physician Assistant (Surgical) | 1611 W HARRISON ST STE 400 CHICAGO, IL 60612 (312) 243-4244 |
1841341179 | DR. GEORGE J KOURIS M.D. Individual | Plastic Surgery | 1611 W HARRISON ST 212 CHICAGO, IL 60612 (312) 432-2850 |
1285767020 | DAVID DONALD CALDARELLI MD Individual | Otolaryngology | 1611 W HARRISON ST SUITE 550 CHICAGO, IL 60612 (312) 942-6100 |
1487774048 | ALLAN J SHOELSON, DPM, PC Organization | Podiatrist (Foot & Ankle Surgery) | 1611 W HARRISON ST SUITE 510 CHICAGO, IL 60612 (312) 563-2800 |
1124232137 | PHILLIP S. LOSAVIO Individual | Otolaryngology | 1611 W HARRISON ST SUITE 550 CHICAGO, IL 60612 (312) 942-6100 |
1619176021 | TRAVIS R SMITH PA-C Individual | Physician Assistant (Surgical) | 1611 W HARRISON ST STE 400 CHICAGO, IL 60612 (312) 243-4244 |
1912198763 | INTERNAL MEDICINE AT RUSH Organization | Internal Medicine | 1611 W HARRISON ST SUITE 510 CHICAGO, IL 60612 (312) 563-4060 |
1871773291 | SONALI KHANDELWAL M.D. Individual | Internal Medicine (Rheumatology) | 1611 W HARRISON ST SUITE 510 CHICAGO, IL 60612 (312) 563-2800 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1659350379, enumerated in the NPI registry as an "individual" on January 11, 2006
The provider is located at 1611 W Harrison St Ste 400 Chicago, Il 60612 and the phone number is (312) 243-4244
The provider's speciality is Orthopaedic Surgery with taxonomy code 207XX0005X with a focus in Sports Medicine
The provider has more than 34 years of experience.
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 May 17, 2024 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 most common procedures or services performed by this practitioner are: X-ray of shoulder, minimum of 2 views, X-ray of knee, 4 or more views, Aspiration and/or injection of large joint or joint capsule, X-ray of knee, 3 views and X-ray of hip with pelvis, 2-3 views.
The practitioner is affiliated to the following hospital(s): RUSH OAK PARK HOSPITAL and SILVER CROSS HOSPITAL AND MEDICAL CENTERS. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
This NPI record was last updated on January 11, 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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