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MR. PRADIP SETHI MD
NPI 1013009653
Psychiatry & Neurology - Sleep Medicine in Elgin, IL

Active since September 29, 2006PECOS EnrolledAccepts Medicare Assignment
40 NORTH AIRLITE ST, SUITE 2, ELGIN, IL 60123(847) 695-0985(847) 695-4373 Get Directions Write a Review

NPPES record last updated: December 21, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Mr. Pradip Sethi Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. PRADIP SETHI MD (NPI 1013009653) is an individual sleep medicine provider in Elgin, Illinois, licensed in Illinois (036055338) and active in the NPI registry since September 2006. He is enrolled in Medicare PECOS, is affiliated with Advocate Sherman Hospital, and is a graduate of Other (1975).

NPPES Registry Identity

NPI1013009653
Entity TypeIndividualMale
Primary Taxonomy2084S0012X
Provider Legal NameMR. PRADIP SETHICredential: MD
Location Address40 NORTH AIRLITE ST, SUITE 2Elgin, IL 60123-4965
Mailing Address40 North Airlite St, Suite 2Elgin, IL 60123-4965 · (847) 695-0985 · Fax (847) 695-4373
Phone(847) 695-0985
Fax(847) 695-4373
Sole ProprietorNo
Medical School CMSOtherGraduated 1975
Enumeration DateSeptember 29, 2006
Last NPPES UpdateDecember 21, 2021
NPPES CertifiedDecember 21, 2021
✔ NPI 1013009653 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · Sleep MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2084S0012X
License✔ Licensed in IL · 036055338
Definition
A Psychiatrist or Neurologist who practices Sleep Medicine is certified in the subspecialty of sleep medicine and specializes in the clinical assessment, physiologic testing, diagnosis, management and prevention of sleep and circadian rhythm disorders. Sleep specialists treat patients of any age and use multidisciplinary approaches. Disorders managed by sleep specialists include, but are not limited to, sleep related breathing disorders, insomnia, hypersomnias, circadian rhythm sleep disorders, parasomnias and sleep related movement disorders.
40 NORTH AIRLITE ST, Elgin, IL 60123
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Other Identifiers 2

OtherP00319590IL · Medicare Railroad Carrier
Other4901097IL · Blue Cross Blue Shield

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Pradip Sethi Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5597732172
PECOS Enrollment IDI20040914000030
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

4

Medicare enrollment records show Pradip Sethi reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Advanced Neurology & Sleep Clinic LLC
Same address
Neurology
40 N AIRLITE ST STE 4
Elgin, IL 60123
  • Reassigned Medicare billing, Illinois enrollment
  • 2 clinicians in this Medicare group
NPI 1407196256 (847) 628-9977
Northwestern Medical Faculty Foundation
3.9 mi
Multi-Specialty
DEPT 5777
Carol Stream, IL 60122
  • Reassigned Medicare billing, Illinois enrollment
  • 4,817 clinicians in this Medicare group
NPI 1346235314 (855) 694-2866
Freeport Regional Health Care Foundation
68 mi
Family Medicine
1036 W STEPHENSON ST
Freeport, IL 61032
  • Reassigned Medicare billing, Illinois enrollment
  • 391 clinicians in this Medicare group
NPI 1457337016 (815) 599-6000
Freeport Memorial Hospital
68 mi
General Acute Care Hospital
1045 W STEPHENSON ST
Freeport, IL 61032
  • Reassigned Medicare billing, Illinois enrollment
  • 478 clinicians in this Medicare group
NPI 1447228788 (815) 599-6000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
364 services191 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
176 services145 patients
New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205
This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.
33 services33 patients
Sleep study in sleep lab with continuous airway pressure (6 years or older) 95811
A sleep study in a sleep lab with continuous airway pressure is a test for individuals aged 6 and above. It monitors your sleep patterns to check for disorders like sleep apnea. Continuous airway pressure helps keep your airways open while you sleep, improving your breathing.
25 services24 patients
Sleep study in sleep lab with continuous airway pressure (6 years or older) 95811
A sleep study in a sleep lab with continuous airway pressure is a test for individuals aged 6 and above. It monitors your sleep patterns to check for disorders like sleep apnea. Continuous airway pressure helps keep your airways open while you sleep, improving your breathing.
22 services20 patients
Sleep study including heart rate, breathing, airflow, and effort 95806
A sleep study monitors your heart rate, breathing patterns, airflow, and physical effort while you sleep. It helps identify sleep disorders by tracking your sleep stages and cycles. This data aids doctors in diagnosing and treating sleep-related issues.
20 services20 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Advocate Sherman Hospital

Acute Care Hospitals · Elgin, IL
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140030
Location1425 North Randall RoadElgin, IL 60123 · Kane County
Emergency services Birthing friendly

Fhn Memorial Hospital

Acute Care Hospitals · Freeport, IL
3/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number140160
Location1045 West Stephenson StreetFreeport, IL 61032 · Stephenson County
Emergency services Birthing friendly

Presence Saint Joseph Hospital - Elgin

Acute Care Hospitals · Elgin, IL
3/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number140217
Location77 N Airlite StreetElgin, IL 60123 · Kane County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60123 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$137.43 typical visit price
range $59.81 – $181.38
Typical copayment $34.35 (range $14.95 – $45.34)
Most-billed visit code 99204
Established Patient
$105.07 typical visit price
range $19.15 – $147.12
Typical copayment $26.26 (range $4.78 – $36.78)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 16

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Tubing with integrated heating element for use with positive airway pressure device A4604
DME-Other DME · category DE001N
19 suppliers630 claims630 services$32.20 avg. paid by Medicare
Full face mask used with positive airway pressure device, each A7030
DME-Other DME · category DE001N
12 suppliers161 claims161 services$70.52 avg. paid by Medicare
Face mask interface, replacement for full face mask, each A7031
DME-Other DME · category DE001N
11 suppliers150 claims430 services$26.21 avg. paid by Medicare
Cushion for use on nasal mask interface, replacement only, each A7032
DME-Other DME · category DE001N
13 suppliers249 claims1,381 services$14.71 avg. paid by Medicare
Pillow for use on nasal cannula type interface, replacement only, pair A7033
DME-Other DME · category DE001N
15 suppliers227 claims1,246 services$12.40 avg. paid by Medicare
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034
DME-Other DME · category DE001N
15 suppliers525 claims525 services$42.85 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pradip Sethi's NPI number?

The NPI number for Pradip Sethi is 1013009653. It was assigned to this individual provider in the NPPES registry on September 29, 2006.

Where is Pradip Sethi located?

Pradip Sethi practices at 40 North Airlite St Suite 2, Elgin, IL 60123. The listed phone number is (847) 695-0985.

What is Pradip Sethi's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Sleep Medicine, with taxonomy code 2084S0012X.

Is Pradip Sethi enrolled in Medicare?

Yes. Pradip Sethi is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Pradip Sethi's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Pradip Sethi reassigns Medicare benefits to 4 organizations: Advanced Neurology & Sleep Clinic LLC (Elgin, IL), Northwestern Medical Faculty Foundation (Carol Stream, IL), Freeport Regional Health Care Foundation (Freeport, IL) and Freeport Memorial Hospital (Freeport, IL). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Pradip Sethi's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Pradip Sethi affiliated with any hospitals?

According to CMS data, Pradip Sethi is affiliated with Advocate Sherman Hospital, Fhn Memorial Hospital and Presence Saint Joseph Hospital - Elgin.

When was this NPI record last updated?

The NPPES record for Pradip Sethi was last updated on December 21, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.