2026 NPPES data Nephrology Physician NPI 1063404481 M.D.
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HAROLD HELTON, M.D.

Nephrology Physician in SOMERSET, Kentucky. CMS National Plan and Provider Enumeration System profile including specialty classification, practice address, and Medicare prescribing data when reported.

Federal data — no proprietary rating. PlainDoctor publishes the actual CMS NPPES and Medicare records — NPI registration, specialty, practice location, and prescribing data — without a composite score or editorial opinion on top. Every field traces to a federal source.
Prescribing volume
1K
Medicare Part D claims · 231 beneficiaries · Nephrology Physician avg: 1K
Generic prescribing
74%
generic claims · 26% brand-name · higher generic rates reduce patient out-of-pocket costs
MIPS score
65.847/100
▼ 17 pts below national avg 83.1 · [object Object]
What the federal data reveals: HAROLD HELTON, M.D. is a Nephrology Physician ([object Object]) practicing in SOMERSET, Kentucky with a Medicare Part D prescribing footprint of 1K claims across 231 beneficiaries — 26% brand-name prescribing . Their CMS MIPS Final Score of 65.847/100 (national average: 83.1) reflects performance across Quality, Cost, Interoperability, and Improvement Activities .

What stands out: HAROLD HELTON, M.D. reported a CMS MIPS final score of 65.847 out of 100, below the 83.1 national average, and filed 1,188 Medicare Part D claims in 2023. Every figure on this page comes straight from federal CMS records, with no proprietary rating applied.

Board certification likely (heuristic — not verified)

HAROLD HELTON, M.D. practices in an ABMS-board-eligible specialty and shows active CMS Medicare participation + MIPS quality reporting — signals consistent with board-certified status. For verified board certification, see CertificationMatters.org (the official ABMS public lookup).

HAROLD HELTON, M.D. at a glance

Below national average

NPI registry status

Active

Issued 08/22/2005

NPI 1063404481

Primary specialty

Nephrology Physician

Mid-sized

10,534 US NPIs in this specialty

Medicare Part D claims

1,188 18% vs specialty avg

2023 prescription claims

Specialty avg: 1,454

MIPS final score

65.847/100 17.253% pts

Mid-tier band

vs 83.1 national avg

Specialty distribution in Kentucky

How Nephrology Physician compares to other specialties among Kentucky providers

Kentucky providers

Nephrology Physician share within Kentucky

1. Nephrology Physician42%2. Internal medicine21%3. Family medicine17%4. Surgical12%5. Pediatric8%
Nephrology Physician share within Kentucky

Medicare quality performance — MIPS

HAROLD HELTON, M.D.'s 2023 MIPS final score plotted against the Nephrology Physician national average

Below national average
MIPS Final Score
65.847/100
vs 83.1 national avg · 2023 performance year

MIPS final score (Nephrology Physician) — 65.847/100 vs national avg 83.1

0%100%National avg83%65.8%
MIPS final score (Nephrology Physician) — 65.847/100 vs national avg 83.1

The Merit-based Incentive Payment System (MIPS) scores providers 0–100 across four performance categories: Quality, Cost, Promoting Interoperability, and Improvement Activities, weighted under 42 CFR §414.1380. Reporting is voluntary for many small practices, so absence of a MIPS score is not a quality signal.

Board certification through an ABMS or AOA member board signals voluntary post-licensure examination plus continuous Maintenance of Certification cycles. Verify any individual provider's status through certificationmatters.org (ABMS) or osteopathic.org (AOA).

HAROLD HELTON, M.D. is a Nephrology Physician provider practicing in SOMERSET, Kentucky, according to the CMS National Plan and Provider Enumeration System (NPPES). Credentials: M.D.. NPI: 1063404481. This profile includes practice location, specialty classification, and organizational affiliations from the CMS provider registry. Provider information is self-reported to CMS and updated monthly.

HAROLD HELTON, M.D. appears in the CMS NPPES registry as a Nephrology Physician provider holding M.D. credentials at 104 HARDIN LN STE A, SOMERSET, KY, 42503, with a listed phone of (606) 678-2063. NPI 1063404481 was issued on 08/22/2005. Because NPPES data is self-reported by the provider and refreshed monthly, the address, phone, and specialty reflect what HELTON most recently submitted to CMS rather than a vetted directory listing, which is why patients should always confirm the practice is still at this location before scheduling.

Medicare Part D records for calendar year 2023 show 1,188 prescription claims written by this provider, covering 231 Medicare beneficiaries and totaling roughly $532K in drug spend, split 26% brand-name and 74% generic by claim count. These figures capture only Medicare Part D — commercial insurance, Medicaid, and cash-pay prescriptions are not included, and any drug-beneficiary cell under 11 is suppressed by CMS for patient privacy. On the CMS Merit-based Incentive Payment System, this provider earned a Final Score of 65.847/100 for the 2023 performance year (Quality 49.7403), compared with the national average of 83.1.

Nephrology Physician is a mid-sized specialty nationwide, with 10,534 enrolled providers across 55 states and an average of 1,454 Part D claims per prescriber, so the context for interpreting these metrics differs meaningfully from a primary-care baseline. Important: PlainDoctor is a directory of publicly available government data, not medical advice, a malpractice database, or a quality rating. Inclusion here does not imply a recommendation, and absence of complaints or sanctions on this page does not mean none exist — always verify credentials through the NPPES NPI Registry, your state medical board, and the ABMS or AOA before making healthcare decisions.

Practice Address

104 HARDIN LN STE A
SOMERSET, KY 42503

Provider Details

NPI 1063404481
Specialty Nephrology Physician
Credentials M.D.
Gender Male
NPI Issued 08/22/2005

CMS Quality Score (MIPS)

Merit-based Incentive Payment System (MIPS) scores from CMS, 2023 performance year.

65.847
Final Score
Avg: 83.1
49.7403
Quality

Reporting: Alternative Payment Model

Brand vs generic prescribing mix · Above average

HAROLD HELTON, M.D. — brand share 26.0%
Specialty average (est.)

26% brand-name claims vs 74% generic, on 1,188 2023 Medicare Part D claims.

The federal Medicare Part D Generic Dispensing Rate national benchmark sits near 90% generic / 10% brand for primary-care prescribers, per CMS Office of the Actuary 2024 estimates. Higher brand share is common in specialty prescribing where generic equivalents are not available.

Medicare Part D Prescribing Data

CMS Medicare Part D prescriber-level data for calendar year 2023.

1,188
Total Claims
$532K
Total Drug Cost
231
Medicare Beneficiaries

Prescribing Breakdown

30-Day Fills
2,081
Total Day Supply
61,786
Brand vs Generic
26% brand / 74% generic
Brand Drug Cost
$463K
Generic Drug Cost
$69K
Antibiotic Claims
12

Patient Demographics

Average Patient Age
66.4 years
Avg HCC Risk Score
5.69
Gender Split
45% female / 55% male
Age Distribution
<65: 79, 65-74: 98, 75-84: N/A, 85+: N/A

Top Prescribed Drugs (Medicare Part D)

Top drugs by claim count for calendar year 2023. Based on Medicare Part D data only.

Drug Claims
Losartan Potassium
164
Calcium Acetate
147
Furosemide
104
Sevelamer Carbonate
97
Auryxia
Ferric Citrate
79
Spironolactone
79
Amlodipine Besylate
62
Torsemide
45
Farxiga
Dapagliflozin Propanediol
33
Carvedilol
31

* Counts below 11 are suppressed by CMS for patient privacy. Generic names shown where available from CMS Part D data.

Nephrology Physician Overview

How HAROLD HELTON, M.D. fits within the Nephrology Physician landscape nationally.

10,534
Nephrology Physician Providers in US
55
States with Nephrology Physician
1,454
Avg Claims per Provider

HAROLD HELTON, M.D.'s 1,188 claims are below the specialty average of 1,454.

Nearby Nephrology Physician Providers in Kentucky

Other clinicians with the same primary specialty enrolled in Kentucky, drawn from the same CMS NPPES roster as HELTON.

Compare Nephrology Physician nationally: see state-by-state distribution →

Frequently Asked Questions

What is HAROLD HELTON, M.D.'s specialty?
HAROLD HELTON, M.D. specializes in Nephrology Physician and practices in SOMERSET, Kentucky. Credentials: M.D..
How much does HAROLD HELTON, M.D. prescribe under Medicare Part D?
In 2023, HAROLD HELTON, M.D. wrote 1,188 Medicare Part D claims totaling $532K in drug costs for 231 beneficiaries.
What is HAROLD HELTON, M.D.'s Medicare quality score?
HAROLD HELTON, M.D. has a CMS MIPS Final Score of 65.847/100 (Quality: 49.7403). The national average MIPS Final Score is 83.1. Source: CMS Merit-based Incentive Payment System (MIPS) 2023.
Where is HAROLD HELTON, M.D. located?
HAROLD HELTON, M.D. is located at 104 HARDIN LN STE A, SOMERSET, KY, 42503. Phone: (606) 678-2063.
What is HAROLD HELTON, M.D.'s NPI number?
HAROLD HELTON, M.D.'s National Provider Identifier (NPI) is 1063404481, issued on 08/22/2005.
Does HAROLD HELTON, M.D. prescribe more brand-name or generic drugs?
HAROLD HELTON, M.D.'s prescribing is 26% brand-name and 74% generic drugs by claim count, with $463K in brand drug costs.
How many Nephrology Physician providers are there in the US?
There are 10,534 Nephrology Physician providers across 55 states in the US. The average Nephrology Physician provider writes 1,454 Medicare Part D claims per year.
What drugs does HAROLD HELTON, M.D. prescribe most often?
Based on 2023 Medicare Part D data, HAROLD HELTON, M.D.'s most frequently prescribed drugs include Losartan Potassium, Calcium Acetate, Furosemide. This reflects Medicare Part D prescriptions only and does not include commercial insurance or other payer types.
Does HAROLD HELTON, M.D. accept Medicare?
HAROLD HELTON, M.D. appears in CMS Medicare data with 1,188 Part D claims and 231 Medicare beneficiaries in 2023. Contact the provider's office directly to confirm current Medicare enrollment and accepted plans.
How can I verify HAROLD HELTON, M.D.'s credentials?
HAROLD HELTON, M.D.'s NPI is 1063404481 with credentials M.D.. You can verify this through the NPPES NPI Registry, check state medical board records, and confirm board certification through the ABMS or AOA.

Data Sources

Provider Directory
CMS National Plan and Provider Enumeration System (NPPES), download.cms.gov/nppes, updated monthly. Contains NPI, specialty, credentials, and practice location.
Specialty Classification
NUCC Health Care Provider Taxonomy (nucc.org), the industry standard for classifying provider specialties in Medicare and Medicaid billing.
Prescribing Data
CMS Medicare Part D Prescriber Public Use File (2023). Includes claims, drug costs, beneficiaries, and opioid prescribing rates.
Quality Performance
CMS Merit-based Incentive Payment System (MIPS) — 2023 performance year.
Limitations
Provider data is self-reported to CMS. Prescribing data reflects Medicare Part D only and does not include commercial insurance, Medicaid, or cash prescriptions. Claims below 11 beneficiaries are suppressed by CMS for privacy.

See our complete data methodology for details on how we collect and process government data.

Data as of April 2026 (NPPES) / 2023 (Medicare Part D). Source: Centers for Medicare & Medicaid Services (CMS).

Disclaimer: Data from CMS NPPES and Medicare Part D. PlainDoctor does not rate or rank providers. Provider information is self-reported and may not be current. Always verify information directly with the provider. About · Methodology