Taxonomy Code 302F00000X(302f00000x)
Exclusive Provider Organization. Providers: 1
Exclusive Provider Organization Providers
| NPI | Name | Type | Address |
|---|---|---|---|
|
Commonwealth Care Alliance |
Organization |
529 Main St Charlestown, MA |
How to obtain, renew, or terminate an NPI
Every health care provider, whether it’s a hospital, pharmacy, or individual specialist, must obtain their own NPI number. This identification number is unique and is assigned upon application. In tod...
| Taxonomy Code | 302F00000X |
| Display Name | Exclusive Provider Organization |
| Taxonomy Group | Managed Care Organizations |
| Taxonomy Classification | Exclusive Provider Organization |
| Definition | (1) An EPO is a form of PPO, in which patients must visit a caregiver that is specified on its panel of providers (is a participating provider). If a visit to an outside(not participating) provider is made the EPO offers very limited or no coverage for the medical service; (2) While similar to a PPO in that an EPO allows patients to go outside the network for care, if they do so in an EPO, they are required to pay the entire cost of care. An EPO differs from an HMO in that EPO physicians do not receive capitation but instead are reimbursed only for actual services provided; (3) An organization identical to a preferred provider organization except that persons enrolled in the plan are eligible to receive benefits only when they use the services of the contracting providers. No benefits are available when non-contracting providers are used, except in certain emergency situations. |
| Effective Date | September 30, 2009 |