DR. VENKATESH SUNDARARAJAN M.D. NPI 1003022500

Pain Medicine - Pain Medicine in Horsham, PA

Individual Male Years of Experience 21 Pain Medicine Pain Medicine PECOS Enrolled Accepts Medicare Approved Payment MIPS Quality Score 84.7 Medicare Quality Reporting

About DR. VENKATESH SUNDARARAJAN M.D.

Venkatesh Sundararajan is a provider established in Horsham, Pennsylvania and his medical specialization is Pain Medicine with more than 21 years of experience. He graduated from University Of Cincinnati College Of Medicine in 2002. The NPI number of Venkatesh Sundararajan is 1003022500 and was assigned on May 2007. The practitioner's primary taxonomy code is 208VP0000X with license number C1-0010968 (DE). The provider is registered as an individual and his NPI record was last updated one year ago.

NPI

1003022500

Provider NameDR. VENKATESH SUNDARARAJAN M.D.
Provider Location Address300 WELSH RD STE 104 HORSHAM, PA 19044
Provider Mailing Address223 WILMINGTON W CHESTER PIKE STE 214 CHADDS FORD, PA 19317
GenderMale
NPI Entity TypeIndividual
Medical School NameUNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE
Graduation Year2002
Is Sole Proprietor?No
Enumeration Date05-14-2007
Last Update Date08-04-2021



Venkatesh Sundararajan 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.

Venkatesh Sundararajan is registered with Medicare and accepts claims assignment, this means the provider accepts Medicare's approved amount for the cost of rendered services as full payment. Participating providers may not charge Medicare beneficiaries more than Medicare's approved amount for their services. Medicare beneficiaries still have to pay a coinsurance or copayment amount for a visit or service. According to Medicare claims data he has hospital affiliations with Doylestown Hospital and Tidalhealth Nanticoke, Inc..

The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 84.7, based on four performance areas: quality, improvement activities, promoting interoperability, and cost. The purpose of this information is to help people with Medicare make informed decisions and incentivize doctors and clinicians to maximize performance. The provider also has detailed performance information the following quality measures: advance care plan, consultation of the prescription drug monitoring program, documentation of current medications in the medical record, documentation of signed opioid treatment agreement, pain assessment and follow-up, preventive care and screening: body mass index (bmi) screening and follow-up plan and provide 24/7 access to mips eligible clinicians or groups who have real-time access to patient's medical record.

The typical physician office visit costs for Medicare beneficiaries in this area are: $35.88 for a new patient copayment and $19.55 for an established patient copayment.



Primary Taxonomy

Taxonomy Code208VP0000X
ClassificationPain Medicine
TypeAllopathic & Osteopathic Physicians
SpecializationPain Medicine
License No.C1-0010968
License StateDE
Taxonomy DescriptionPain Medicine is a primary medical specialty based on a distinct body of knowledge and a well-defined scope of clinical practice that is founded on science, research and education. It is concerned with the study of pain, the prevention of pain, and the evaluation, treatment, and rehabilitation of persons in pain. A comprehensive evaluation incorporates the physical, psychological, cognitive and socio-cultural contributions to pain. The treatment protocol may include pharmacological, invasive, behavioral, cognitive, rehabilitative and complementary strategies provided in a concurrent focused and patient specific manner. The pain medicine physician often serves the patient as a frontline physician regarding their pain, but also may serve as a consultant to other physicians, direct an interdisciplinary/multidisciplinary treatment team, conduct research, or advocate for the patient's pain care with public and private agencies. The Pain Medicine physician may work in variety of settings including office, clinic, hospital, university, or governmental/public agencies.

Business Address

DR. VENKATESH SUNDARARAJAN M.D.
300 WELSH RD STE 104
HORSHAM, PA
ZIP 19044
Phone: (844) 365-7246
Fax: (215) 706-4191

Get Directions


Mailing Address

DR. VENKATESH SUNDARARAJAN M.D.
223 WILMINGTON W CHESTER PIKE STE 214
CHADDS FORD, PA
ZIP 19317
Phone: (844) 365-7246
Fax: (610) 361-7956


Secondary Locations

2701 Blair Mill Rd #35
Willow Grove, PA 19090
(215) 957-1108
405 Silverside Rd Ste 104
Wilmington, DE 19809
(302) 894-2881
160 N Pointe Blvd Ste 208
Lancaster, PA 17601
(844) 365-7246
100 Arrandale Blvd Ste 103
Exton, PA 19341
(844) 365-7246
931 E Haverford Rd Ste 202
Bryn Mawr, PA 19010
(844) 365-7246
1235 Penn Ave Ste 302
Wyomissing, PA 19610
(844) 365-7246
535 Pennsylvania Ave
Fort Washington, PA 19034
(844) 365-7246
3105 Limestone Rd Ste 300
Wilmington, DE 19808
(844) 365-7246
1197 Airport Rd Fl 2
Milford, DE 19963
(844) 365-7246
118 Sandhill Dr Ste 203
Middletown, DE 19709
(844) 365-7246
3401 Brandywine Pkwy Ste 202
Wilmington, DE 19803
(844) 365-7246
4701 Ogletown Stanton Rd Ste 1200
Newark, DE 19713
(844) 365-7246

PECOS Enrollment and Medicare Participation

What is PECOS?
PECOS is the Medicare Provider, Enrollment, Chain and Ownership System. PECOS is Medicare's enrollment and revalidation system and it is the primary source of information about verified Medicare professionals. A NPI number is necessary to register in PECOS. Providers must enroll in PECOS to avoid denied claims.

Registered in PECOS? Yes
PECOS PAC ID7012009236
PECOS Enrollment IDI20080219000096, I20151118000784
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 order / refer Part B Clinical Laboratory and ImagingYes
Eligible order / refer Durable Medical EquipmentYes
Eligible order / refer Home Health Agency (HHA)Yes
Eligible order / refer Power Mobility DevicesYes

Physician Office Visit Costs

The provider accepts as payment the Medicare approved amount. Medicare beneficiaries should not be billed for more than the Medicare deductible and coinsurance amounts. Medicare pricing is usually a reference point for private insurance covered patients. The prices below reflect the costs for new and established patients in the 19044 ZIP code area.

New Patients Office Visits Costs *
Most Utilized Procedure Code for new patients office visits: 99204
Minimum New Patient Pricing Maximum New Patient Pricing Typical New Patient Pricing
$62.8 $189.43 $143.54
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$15.7 $47.35 $35.88
Established Patients Office Visits Costs *
Most Utilized Procedure Code for established patients office visits: 99213
Minimum Established Patient Pricing Maximum Established Patient Pricing Typical Established Patient Pricing
$19.68 $154.62 $78.22
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$4.92 $38.65 $19.55

* The physician office visit costs information is obtained by Medicare's statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Overall MIPS Quality Performance

The Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in Medicare's Quality Payment Program (QPP). The MIPS program affects clinician reimbursement for Part B covered professional services and also rewards them for improving the quality of patient care and outcomes.

MIPS Measure Score Weight Score
Quality 40% 78
The Quality category assesses providers performance on clinical practices and patient outcomes under the traditional MIPS program. The quality measures help identify the quality of healthcare processes, outcomes, and patient experiences. The Quality measure category compromises 40% providers final MPIS scores.

There are six collection types for MIPS quality measures: Electronic Clinical Quality Measures (eCQMs), MIPS Clinical Quality Measures (CQMs), Qualified Clinical Data Registry (QCDR) Measures, Medicare Part B claims measures, CMS Web Interface measures and The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey.
Promoting Interoperability (PI) 25% N/A
The Interoperability category measures the providers ability to use technology to exchange and make use of healthcare information in a way that is less burdensome and improves outcomes. The Interoperability measure category compromises 25% providers final MPIS scores.

The MIPS Interoperability measure focuses on the use of certified electronic health record technology (CEHRT) to improve patient access health information, the exchange of information between clinicians and pharmacies and the systematic collection, analysis, and interpretation of healthcare data.
Improvement Activities 15% 40
The Improvement Activities performance category evaluates the providers participation in clinical activities that support the improvement of clinical practice, care delivery, and outcomes. Providers have the option to choose 2 to 4 activities from an inventory of over 100 improvement activities. Providers typically choose the activities that best fit their needs.

The Improvement measures aim to better patient engagement, patient safety and other areas of patient care. The Improvement Activities category compromises 15% of providers final MPIS scores.
Cost 20% N/A
The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.

Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.
MIPS Final Score - 84.7
The MIPS program evaluates providers across multiple categories with a specific weight for each category resulting a in a MIPS final score that ranges from 0 to 100 points. The MIPS Final Score determines whether providers receive a negative, neutral or positive MIPS payment adjustment.

MIPS Quality Measures

The following performance measures were reported under the Merit-Based Incentive Payment System (MIPS) and Qualified Clinical Data Registry (QCDR) quality measures program.

Quality Measure Performance Number of Patients
Advance Care Plan 85% 544
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan
Consultation of the Prescription Drug Monitoring ProgramYesN/A
Clinicians would attest to reviewing the patients' history of controlled substance prescription using state prescription drug monitoring program (PDMP) data prior to the issuance of a Controlled Substance Schedule II (CSII) opioid prescription lasting longer than 3 days. For the transition year, clinicians would attest to 60 percent review of applicable patient's history. For the Quality Payment Program Year 2 and future years, clinicians would attest to 75 percent review of applicable patient's history performance.
Documentation of Current Medications in the Medical Record 96% 3969
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration
Documentation of Signed Opioid Treatment Agreement 100% 1449
All patients 18 and older prescribed opiates for longer than six weeks duration who signed an opioid treatment agreement at least once during Opioid Therapy documented in the medical record
Pain Assessment and Follow-Up 67% 1713
Percentage of visits for patients aged 18 years and older with documentation of a pain assessment using a standardized tool(s) on each visit AND documentation of a follow-up plan when pain is present
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 81% 1060
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounterNormal Parameters: Age 18 years and older BMI => 18.5 and < 25 kg/m2
Provide 24/7 Access to MIPS Eligible Clinicians or Groups Who Have Real-Time Access to Patient's Medical RecordYesN/A
- Provide 24/7 access to MIPS eligible clinicians, groups, or care teams for advice about urgent and emergent care (e.g., MIPS eligible clinician and care team access to medical record, cross-coverage with access to medical record, or protocol-driven nurse line with access to medical record) that could include one or more of the following:- Expanded hours in evenings and weekends with access to the patient medical record (e.g., coordinate with small practices to provide alternate hour office visits and urgent care);- Use of alternatives to increase access to care team by MIPS eligible clinicians and groups, such as e-visits, phone visits, group visits, home visits and alternate locations (e.g., senior centers and assisted living centers); and/orProvision of same-day or next-day access to a consistent MIPS eligible clinician, group or care team when needed for urgent care or transition management.

Clinician Utilization

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 2017. The reported codes are based on the top 5 codes for each available Medicare specialty, excluding evaluation and management codes.

  • 219Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance (HCPCS:64483)
  • 153Injections of substances into lower or sacral spine (HCPCS:62311)
  • 151Injection, dexamethasone sodium phosphate, 1mg (HCPCS:J1100)
  • 49Injections of lower or sacral spine facet joint using imaging guidance (HCPCS:64493)
  • 48Injections of lower or sacral spine facet joint using imaging guidance (HCPCS:64494)
  • 45Aspiration and/or injection of large joint or joint capsule (HCPCS:20610)
  • 26Injection beneath the skin or into muscle for therapy, diagnosis, or prevention (HCPCS:96372)
  • 18Injection, methylprednisolone acetate, 40 mg (HCPCS:J1030)

Hospital Affiliations

Medicare hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the Medicare 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. Venkatesh Sundararajan is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
DOYLESTOWN HOSPITAL595 WEST STATE ST
DOYLESTOWN, PA 18901
(215) 345-2200Acute Care Hospitals390203
TIDALHEALTH NANTICOKE, INC.801 MIDDLEFORD RD
SEAFORD, DE 19973
(302) 629-6611Acute Care Hospitals80006

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineMD422810PANo

Taxonomy Description: an anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists.

2208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineMD428810PANo

Taxonomy Description: pain Medicine is a primary medical specialty based on a distinct body of knowledge and a well-defined scope of clinical practice that is founded on science, research and education. It is concerned with the study of pain, the prevention of pain, and the evaluation, treatment, and rehabilitation of persons in pain. A comprehensive evaluation incorporates the physical, psychological, cognitive and socio-cultural contributions to pain. The treatment protocol may include pharmacological, invasive, behavioral, cognitive, rehabilitative and complementary strategies provided in a concurrent focused and patient specific manner. The pain medicine physician often serves the patient as a frontline physician regarding their pain, but also may serve as a consultant to other physicians, direct an interdisciplinary/multidisciplinary treatment team, conduct research, or advocate for the patient's pain care with public and private agencies. The Pain Medicine physician may work in variety of settings including office, clinic, hospital, university, or governmental/public agencies.

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.
1003022500
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
200302450
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 0 + 0 + 3 + 0 + 2 + 4 + 5 + 0 + 24 = 40
Step 3: because the number obtained in step 2 ends in zero, the check digit is zero.
0

The NPI number 1003022500 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the same location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1023599438CENTER FOR INTERVENTIONAL PAIN SPINE LLC
Organization
Durable Medical Equipment & Medical Supplies300 WELSH RD STE 104
HORSHAM, PA 19044
(844) 365-7246
1881846749 MICHELLE LEE CAPORALETTI D.O.
Individual
Pain Medicine (Pain Medicine)300 WELSH RD STE 104
HORSHAM, PA 19044
(844) 365-7246

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
Dr. Venkatesh Sundararajan M.d. is registered as an entity type code: 1. The entity type code describes the type of health care provider that is being assigned an NPI. The entity type codes are:

  • 1 = Person: individual human being who furnishes health care.
  • 2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.