Active NPI 1265435580 Individual Practitioner Male Practitioner

Dr. Todd Allen Helfman , MD

Dermatology • Minden, NV

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Todd Helfman, MD is a certified Dermatology practicing in Minden, NV. With approximately 35 years of clinical experience since graduating from Saint Louis University School Of Medicine in 1991, Dr. Helfman delivers high-quality medical care to the local community at 1661 LUCERNE ST.

Dr. Helfman is affiliated with Alpine Dermatology Llc and accepts Medicare assignment.

Frequently performed procedures and clinical services include destruction of precancer skin growth, 2-14 growths, established patient outpatient office visit, tangential biopsy of single skin lesion. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1661 Lucerne St

Minden, NV 894234381

Telephone 7757820700

Fax 7757820500

Associated Practice Facility / Clinic

🏢 Tck Islay, Inc Facility NPI 1336773373

Medicare Profile & Education

Medical School

Saint Louis University School Of Medicine

Graduation Year

1991

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology in Minden, NV

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

35 Yrs +7.0 yrs vs City Avg

City Avg: 28.0 Yrs

State Avg: 19.7 Yrs

Regional Practice Density

4 Specialists

Practicing in Minden, NV (93 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

18.7% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Helfman (35 Years) 35 Yrs

Minden Specialty Average (28.0 Years) 28.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,105	205	$6.80	$6.54
99213 Established patient office or other outpatient visit, typically 15 minutes	713	481	$91.16	$88.88
11102 Tangential biopsy of single skin lesion	482	362	$103.61	$96.53
11103 Biopsy of related skin growth, each additional growth	429	192	$51.32	$49.18
17000 Destruction of skin growth	354	281	$68.33	$45.14
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	83	83	$113.43	$108.91
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	65	63	$57.61	$55.39
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	60	38	$182.25	$154.36
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	34	30	$284.82	$148.31
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	33	32	$481.69	$458.14
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	31	27	$273.16	$160.86
17004 Destruction of precancer skin growth, 15 or more growths	31	26	$172.39	$164.03
69100 Biopsy of ear	30	28	$98.62	$67.05
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	28	23	$249.58	$119.79
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	27	25	$128.92	$125.15
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	25	24	$434.56	$414.47
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	24	20	$310.37	$291.23
17110 Destruction of up to 14 skin growths	20	20	$115.81	$111.86
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	15	15	$150.88	$131.40
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	12	12	$257.78	$155.27

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,295	220	$6.79	$6.67
99213 Established patient office or other outpatient visit, typically 15 minutes	717	478	$91.06	$89.80
11102 Tangential biopsy of single skin lesion	508	379	$103.55	$99.63
11103 Biopsy of related skin growth, each additional growth	480	216	$51.29	$50.34
17000 Destruction of skin growth	375	282	$68.20	$48.92
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	113	113	$113.46	$110.78
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	66	63	$57.00	$56.25
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	52	35	$181.91	$160.18
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	45	38	$480.91	$473.24
17004 Destruction of precancer skin growth, 15 or more growths	37	26	$171.94	$169.41
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	34	27	$249.40	$126.45
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	34	34	$128.55	$126.96
69100 Biopsy of ear	30	27	$98.30	$72.72
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	27	24	$434.17	$419.34
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	26	22	$272.65	$155.22
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	23	21	$284.22	$140.32
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	21	20	$310.01	$297.83
11104 Punch biopsy, first skin growth	17	15	$128.08	$126.45
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	15	14	$256.94	$160.92
17110 Destruction of up to 14 skin growths	15	14	$115.24	$113.77
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	13	11	$406.33	$399.81
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	13	12	$150.88	$119.94

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,141	195	$6.87	$6.79
99213 Established patient office or other outpatient visit, typically 15 minutes	682	457	$93.70	$92.63
11102 Tangential biopsy of single skin lesion	464	360	$106.75	$103.82
11103 Biopsy of related skin growth, each additional growth	363	180	$53.73	$52.65
17000 Destruction of skin growth	339	262	$69.28	$49.86
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	89	89	$116.13	$115.10
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	63	58	$58.22	$57.64
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	41	39	$131.91	$130.12
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	38	30	$185.45	$169.11
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	38	36	$318.38	$314.35
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	35	33	$495.69	$489.42
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	32	29	$280.58	$142.95
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	28	26	$291.42	$144.01
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	27	27	$255.60	$126.13
17004 Destruction of precancer skin growth, 15 or more growths	25	21	$173.72	$171.81
11104 Punch biopsy, first skin growth	19	18	$132.64	$130.79
69100 Biopsy of ear	18	16	$101.02	$71.91
99202 New patient office or other outpatient visit, typically 20 minutes	14	14	$75.30	$74.64
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	13	13	$173.00	$171.07
12034 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 7.6-12.5 cm	12	12	$351.40	$349.28

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,034	199	$6.64	$6.68
99213 Established patient office or other outpatient visit, typically 15 minutes	637	451	$93.09	$93.94
11102 Tangential biopsy of single skin lesion	454	350	$107.15	$106.17
11103 Biopsy of related skin growth, each additional growth	424	196	$54.80	$55.01
17000 Destruction of skin growth	336	278	$68.03	$50.62
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	102	102	$115.92	$115.54
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	79	69	$57.07	$57.63
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	47	45	$132.87	$133.54
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	41	37	$319.78	$315.75
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	38	33	$292.49	$155.85
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	37	29	$184.63	$174.19
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	31	31	$497.98	$504.04
12034 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 7.6-12.5 cm	24	23	$350.06	$354.29
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	23	23	$281.57	$154.93
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	22	19	$257.15	$130.13
11104 Punch biopsy, first skin growth	16	16	$134.56	$136.18
17004 Destruction of precancer skin growth, 15 or more growths	13	11	$171.08	$173.14
99202 New patient office or other outpatient visit, typically 20 minutes	11	11	$75.72	$75.82

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	782	153	$6.19	$6.14
99213 Established patient office or other outpatient visit, typically 15 minutes	426	342	$76.76	$76.99
11102 Tangential biopsy of single skin lesion	399	315	$103.38	$101.27
11103 Biopsy of related skin growth, each additional growth	311	149	$54.72	$54.78
17000 Destruction of skin growth	267	216	$67.90	$49.76
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	163	138	$111.46	$112.21
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	101	94	$46.43	$46.78
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	38	34	$311.93	$306.07
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	37	29	$183.90	$155.85
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	31	31	$110.28	$110.88
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	28	25	$255.06	$133.17
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	27	25	$498.27	$487.43
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	22	21	$290.92	$159.76
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	20	19	$279.61	$166.28
99201 New patient office or other outpatient visit, typically 10 minutes	19	19	$46.88	$47.22
69100 Biopsy of ear	18	15	$102.07	$67.78
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	15	14	$263.83	$152.69
99202 New patient office or other outpatient visit, typically 20 minutes	14	14	$77.85	$78.22
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	13	13	$152.74	$133.35
11104 Punch biopsy, first skin growth	12	12	$129.09	$124.88
12034 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 7.6-12.5 cm	12	12	$335.84	$323.98

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,341	231	$5.95	$5.71
11102 Tangential biopsy of single skin lesion	462	369	$102.93	$98.79
99213 Established patient office or other outpatient visit, typically 15 minutes	442	356	$76.31	$75.14
17000 Destruction of skin growth	395	285	$67.54	$48.69
11103 Biopsy of related skin growth, each additional growth	390	183	$55.21	$54.40
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	211	164	$111.37	$109.54
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	171	142	$46.32	$45.82
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	123	123	$111.13	$109.98
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	45	35	$181.87	$170.74
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	43	41	$505.29	$477.47
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	42	40	$315.90	$306.68
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	38	35	$285.34	$155.84
99202 New patient office or other outpatient visit, typically 20 minutes	31	31	$78.01	$77.71
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	31	27	$259.88	$128.29
69100 Biopsy of ear	28	24	$103.75	$63.88
17004 Destruction of precancer skin growth, 15 or more growths	27	22	$161.46	$146.60
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	27	25	$297.41	$141.36
99201 New patient office or other outpatient visit, typically 10 minutes	25	25	$47.58	$46.11
11104 Punch biopsy, first skin growth	20	19	$128.16	$127.42
12034 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 7.6-12.5 cm	13	13	$329.06	$314.53

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,294	213	$5.54	$5.35
11100 Biopsy of single growth of skin and/or tissue	458	358	$110.23	$102.92
11101 Biopsy of each additional growth of skin and/or tissue	381	198	$34.08	$32.57
17000 Destruction of skin growth	371	268	$69.08	$47.97
99213 Established patient office or other outpatient visit, typically 15 minutes	267	211	$75.48	$73.19
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	213	213	$111.13	$108.18
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	191	156	$110.83	$108.17
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	157	136	$46.28	$44.02
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	70	51	$183.97	$159.39
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	58	49	$495.32	$477.05
99201 New patient office or other outpatient visit, typically 10 minutes	45	45	$46.37	$45.05
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	45	39	$326.21	$293.51
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	39	35	$280.72	$145.11
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	37	33	$265.40	$127.00
17004 Destruction of precancer skin growth, 15 or more growths	31	27	$156.20	$137.24
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	29	27	$308.44	$150.58
69100 Biopsy of ear	26	23	$104.28	$69.09
99202 New patient office or other outpatient visit, typically 20 minutes	19	19	$76.83	$75.86
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	14	12	$265.74	$139.85

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,062	181	$6.02	$5.71
11100 Biopsy of single growth of skin and/or tissue	435	346	$110.19	$102.69
11101 Biopsy of each additional growth of skin and/or tissue	351	172	$34.85	$32.81
99213 Established patient office or other outpatient visit, typically 15 minutes	334	261	$76.91	$73.67
17000 Destruction of skin growth	322	241	$69.85	$49.54
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	213	186	$45.76	$43.98
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	165	165	$112.19	$109.29
99201 New patient office or other outpatient visit, typically 10 minutes	65	65	$46.34	$44.61
99202 New patient office or other outpatient visit, typically 20 minutes	51	51	$78.11	$74.56
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	48	39	$183.43	$162.48
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	43	42	$319.24	$299.79
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	42	38	$500.48	$487.02
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	34	33	$110.53	$108.79
17004 Destruction of precancer skin growth, 15 or more growths	34	27	$162.88	$150.44
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	29	27	$292.63	$153.30
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	28	26	$262.31	$136.06
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	26	24	$295.03	$150.56
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	20	19	$278.96	$137.81
69100 Biopsy of ear	19	19	$106.25	$71.26

Medical Specialties & State Licenses

CMS Verified: 2024-07-19

Dermatology Primary Specialty

NUCC Taxonomy Code: 207N00000X

State License NV 16150

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Dermatology

NUCC Taxonomy Code: 207N00000X

State License NC 98-01669

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID Medical License Number

16150 (NV)

Commercial Insurance / Payer ID Group Npi

1841429263 (NV)

Commercial Insurance / Payer ID Nc Medical Liscence Numbe

98-01669 (NC)

Commercial Insurance / Payer ID Medicare Ptan

BX462A (NV)

Hospital & Practice Group Affiliations

Alpine Dermatology Llc

1661 Lucerne St, Minden, NV 894234381

Phone: 7757820700

Alpine Dermatology Llc

1661 Lucerne St, Minden, NV 894234306

Alpine Dermatology Llc

1624 10th St, Minden, NV 894234477

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners

Dr. Dan Rowe , MD

Dermatology

NPI 1053314708

Doctor of Medicine (M.D.)

Dr. Diane Sheridan , MD

Dermatology

NPI 1588619555

Doctor of Medicine (M.D.)

Dr. Mark Juhl , MD

Dermatology

NPI 1912391897

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

9 Historical Events

📍

Updated Practice Location July 19, 2024

Registered at 1661 LUCERNE ST, MINDEN, NV 894234381 (Tel: 7757820700)

📍

Updated Business Mailing Address July 19, 2024

Registered at 1661 LUCERNE ST, MINDEN, NV 894234381 (Tel: 7757820700)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 19, 2024

Dermatology (License #98-01669 in NC)

✅

NPI Profile Active December 15, 2016

NPI status registered as active in NPPES database

📍

Updated Practice Location December 15, 2016

Registered at 1624 10TH ST, SUITE 1, MINDEN, NV 894234481 (Tel: 7757820700)

📍

Updated Business Mailing Address December 15, 2016

Registered at 1624 10TH ST, SUITE 1, MINDEN, NV 894234481 (Tel: 7757820700)

👤

Provider Name / Credentials Updated December 15, 2016

Recorded as TODD HELFMAN, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) December 15, 2016

Dermatology (License #98-01669 in NC)

🟢

Initial NPI Registration & Enumeration May 31, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1265435580

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: May 31, 2005

Last Update: July 19, 2024

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

1661 Lucerne St

Minden, NV 894234381

Phone: 7757820700

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.