Active NPI 1790936631 Individual Practitioner Male Practitioner

Dr. James Patrick O'toole , MD

Plastic Surgery • Pittsburgh, PA

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. James O'Toole, MD is a certified Plastic Surgery practicing in Pittsburgh, PA. With approximately 27 years of clinical experience since graduating from Saint Louis University School Of Medicine in 1999, Dr. O'Toole delivers high-quality medical care to the local community at 5830 ELLSWORTH AVE.

Dr. O'Toole accepts Medicare assignment.

Frequently performed procedures and clinical services include established patient outpatient office visit, new patient outpatient office visit, initial hospital care with moderate level of medical decision making, if using time, at least. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

5830 Ellsworth Ave
Suite 300

Pittsburgh, PA 152321778

Telephone 4123451615

Fax 4123451613

Associated Practice Facility / Clinic

🏢 O'toole Plastic Surgery, Pc Facility NPI 1760725139

Medicare Profile & Education

Medical School

Saint Louis University School Of Medicine

Graduation Year

1999

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Plastic Surgery in Pittsburgh, PA

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

27 Yrs +7.6 yrs vs City Avg

City Avg: 19.4 Yrs

State Avg: 28.1 Yrs

Regional Practice Density

39 Specialists

Practicing in Pittsburgh, PA (239 Statewide)

Telehealth Adoption Rate

15.4% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

16.1% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. O'toole (27 Years) 27 Yrs

Pittsburgh Specialty Average (19.4 Years) 19.4 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
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	13	12	$145.00	$121.63

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	16	16	$200.00	$161.85
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	16	14	$145.00	$122.25
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	16	16	$257.00	$210.52

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	17	17	$257.00	$215.55

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	22	14	$145.00	$127.03
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	14	14	$257.00	$217.57
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	14	13	$200.00	$177.60

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	20	15	$288.00	$199.68
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	13	13	$134.00	$106.68
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	11	11	$264.09	$204.37

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17250 Application of chemical to stop tissue regrowth in wound	40	21	$101.00	$32.48
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	29	24	$288.00	$192.58
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	24	14	$134.00	$75.77
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	23	16	$134.00	$102.72
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	21	13	$75.00	$42.18
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	15	12	$109.00	$69.49
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	11	11	$285.36	$194.89

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17250 Application of chemical to stop tissue regrowth in wound	115	27	$101.00	$30.56
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	82	22	$134.00	$73.07
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	32	26	$288.00	$188.67
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	27	17	$155.48	$98.59
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	19	12	$109.00	$67.70
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	17	12	$149.00	$96.97
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	17	12	$184.53	$103.32
99213 Established patient office or other outpatient visit, typically 15 minutes	17	15	$118.65	$66.81
11042 Removal of skin and tissue, 20.0 sq cm or less	15	11	$264.00	$52.47
11000 Removal of inflamed or infected skin, up to 10% of body surface	13	11	$50.00	$18.75

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17250 Application of chemical to stop tissue regrowth in wound	120	39	$101.00	$28.89
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	53	19	$135.08	$72.17
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	42	35	$288.00	$185.89
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	32	15	$109.00	$66.19
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	23	15	$180.00	$101.97
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	16	16	$261.88	$187.50
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	12	12	$134.00	$96.97
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	12	12	$225.00	$148.77
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	11	11	$207.18	$119.05

Medical Specialties & State Licenses

Plastic Surgery Primary Specialty

NUCC Taxonomy Code: 208200000X

State License PA MD421397

A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.

Practice Associates & Co-Workers

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

5 Associated Practitioners

Jordan Stash , MS, NCC, LPC

Counselor - Professional

NPI 1043804685

Master of Science, National Certified Counselor, Licensed Professional Counselor

Sandra Mccool , PT

Physical Therapist

NPI 1225355159

Physical Therapist

Jeffrey Falleroni , SLP

Speech-Language Pathologist

NPI 1417274341

Speech-Language Pathologist

Megan Tomley , LPC

Counselor - Professional

NPI 1467348169

Licensed Professional Counselor

Michael Sittig , MICHAEL SITTIG

Psychologist - Rehabilitation

NPI 1538281894

MICHAELSITTIG

Career & Practice History Timeline

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

6 Historical Events

✅

NPI Profile Active November 21, 2014

NPI status registered as active in NPPES database

📍

Updated Practice Location November 21, 2014

Registered at 5830 ELLSWORTH AVE, SUITE 300, PITTSBURGH, PA 152321778 (Tel: 4123451615)

📍

Updated Business Mailing Address November 21, 2014

Registered at 5830 ELLSWORTH AVE, SUITE 300, PITTSBURGH, PA 152321778 (Tel: 4123451615)

👤

Provider Name / Credentials Updated November 21, 2014

Recorded as JAMES O'TOOLE, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) November 21, 2014

Plastic Surgery (License #MD421397 in PA)

🟢

Initial NPI Registration & Enumeration October 09, 2008

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1790936631

Entity Type:

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

Enumeration Date: October 09, 2008

Last Update: November 21, 2014

Sole Proprietor: No

Update or Correct Profile

Mailing Address

5830 Ellsworth Ave, Suite 300

Pittsburgh, PA 152321778

Phone: 4123451615

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.