DR. JONATHAN SEHY M.D., PH.D. NPI 1013081942
Radiology - Diagnostic Radiology in Maryville, IL

About DR. JONATHAN SEHY M.D., PH.D.

Jonathan Sehy is a provider established in Maryville, Illinois and his medical specialization is Radiology with a focus in diagnostic radiology with more than 20 years of experience. He graduated from Washington University School Of Medicine in 2003. The NPI number of Jonathan Sehy is 1013081942 and was assigned on November 2006. The practitioner's primary taxonomy code is 2085R0202X with license number 036.122442 (IL). The provider is registered as an individual and his NPI record was last updated 12 years ago.

NPI
1013081942
Provider NameDR. JONATHAN SEHY M.D., PH.D.
Location Address6800 STATE ROUTE 162 ANDERSON HOSPITAL, DEPT. OF RADIOLOGY MARYVILLE, IL 62062
Location Phone(314) 359-3166
Mailing Address6800 STATE ROUTE 162 ANDERSON HOSPITAL, DEPT. OF RADIOLOGY MARYVILLE, IL 62062
GenderMale
NPI Entity TypeIndividual
Medical School NameWASHINGTON UNIVERSITY SCHOOL OF MEDICINE
Graduation Year2003
Is Sole Proprietor?No
Enumeration Date11-20-2006
Last Update Date02-07-2011

Jonathan Sehy 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.

Jonathan Sehy 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 Anderson Hospital, Community Hospital Of Staunton, Alton Memorial Hospital and Gateway Regional Medical Center.

The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 98.5, 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: radiology: exposure dose indices or exposure time and number of images reported for procedures using fluoroscopy.

The typical physician office visit costs for Medicare beneficiaries in this area are: $22.83 for a new patient copayment and $18.44 for an established patient copayment.



Primary Taxonomy

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.

Taxonomy Code2085R0202X
ClassificationRadiology
TypeAllopathic & Osteopathic Physicians
SpecializationDiagnostic Radiology
License No.036.122442
License StateIL
Taxonomy DescriptionA radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Accepted Insurance

The NPI profile data indicates this provider might be enrolled and accepting insurance plans from the following companies or healthcare programs:

  • Medicaid
  • Medicare

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Business Address

DR. JONATHAN SEHY M.D., PH.D.
6800 STATE ROUTE 162
ANDERSON HOSPITAL, DEPT. OF RADIOLOGY
MARYVILLE, IL
ZIP 62062
Phone: (314) 359-3166

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Mailing Address

DR. JONATHAN SEHY M.D., PH.D.
6800 STATE ROUTE 162
ANDERSON HOSPITAL, DEPT. OF RADIOLOGY
MARYVILLE, IL
ZIP 62062
Phone: (314) 359-3166


Location Map

PECOS Enrollment and Medicare Participation Status

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 ID9931272226
PECOS Enrollment IDI20090624000585
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 62062 ZIP code area.

New Patients Office Visits Costs *
Most Utilized Procedure Code for new patients office visits: 99203
Minimum New Patient Pricing Maximum New Patient Pricing Typical New Patient Pricing
$59.05 $180.96 $91.32
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$14.76 $45.24 $22.83
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
$17.84 $146.8 $73.79
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$4.46 $36.7 $18.44

* 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% 95.4
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 - 98.5
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
Radiology: Exposure Dose Indices or Exposure Time and Number of Images Reported for Procedures Using Fluoroscopy 98% 94
Final reports for procedures using fluoroscopy that document radiation exposure indices, or exposure time and number of fluorographic images (if radiation exposure indices are not available)

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.

  • 638X-ray of chest, 2 views, front and side (HCPCS:71020)
  • 571X-ray of chest, 1 view, front (HCPCS:71010)
  • 178Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck (HCPCS:93880)
  • 173X-ray of abdomen, single view (HCPCS:74000)
  • 162CT scan of abdomen and pelvis with contrast (HCPCS:74177)
  • 160CT scan of abdomen and pelvis (HCPCS:74176)
  • 114X-ray of ribs of one side of body, minimum of 2 views (HCPCS:73510)
  • 100X-ray of knee, 4 or more views (HCPCS:73564)
  • 100Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers (HCPCS:93971)
  • 84Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers (HCPCS:93970)
  • 81X-ray of shoulder, minimum of 2 views (HCPCS:73030)
  • 72Nuclear medicine study of vessels of heart using drugs or exercise multiple studies (HCPCS:78452)
  • 43X-ray of foot, minimum of 3 views (HCPCS:73630)
  • 36X-ray of hand, minimum of 3 views (HCPCS:73130)
  • 35X-ray of wrist, minimum of 3 views (HCPCS:73110)
  • 34Ultrasonic guidance imaging supervision and interpretation for insertion of needle (HCPCS:76942)
  • 33Ultrasound of head and neck (HCPCS:76536)
  • 31Bone and/or joint imaging, whole body (HCPCS:78306)
  • 26Aspiration and/or injection of large joint or joint capsule (HCPCS:20610)
  • 25Nuclear medicine study with CT imaging skull base to mid-thigh (HCPCS:78815)
  • 23Nuclear medicine study of lung ventilation and blood circulation in the lungs (HCPCS:78582)
  • 21Fine needle aspiration using imaging guidance (HCPCS:10022)
  • 13Ultrasound study of arteries of both arms and legs (HCPCS:93922)

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. Jonathan Sehy is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
ANDERSON HOSPITAL6800 STATE ROUTE 162
MARYVILLE, IL 62062
(618) 288-5711Acute Care Hospitals140289
COMMUNITY HOSPITAL OF STAUNTON400 N CALDWELL ST
STAUNTON, IL 62088
(618) 635-2200Critical Access Hospitals141306
ALTON MEMORIAL HOSPITALONE MEMORIAL DRIVE
ALTON, IL 62002
(618) 463-7300Acute Care Hospitals140002
GATEWAY REGIONAL MEDICAL CENTER2100 MADISON AVENUE
GRANITE CITY, IL 62040
(618) 798-3000Acute Care Hospitals140125

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
12085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology2004014818MONo

Taxonomy Description: a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
994000002MEDICARE PIN (08)

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.
1013081942
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
202308298
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 0 + 2 + 3 + 0 + 8 + 2 + 9 + 8 + 24 = 58
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 58 = 22

The NPI number 1013081942 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1336122738 NAMIR MREYOUD MD
Individual
Surgery6800 STATE ROUTE 162
MARYVILLE, IL 62062
(800) 968-6866
1891778254 SAMUEL A BAILEY PA
Individual
Physician Assistant6800 STATE ROUTE 162
MARYVILLE, IL 62062
(800) 968-6866
1417930470 DANUTA J PIKUL MD
Individual
Emergency Medicine6800 STATE ROUTE 162
MARYVILLE, IL 62062
(800) 968-6866
1497726251DR. JAMES S POWELL MD
Individual
Anesthesiology6800 STATE ROUTE 162 DEPT. OF ANESTHESIOLOGY
MARYVILLE, IL 62062
(618) 288-5711
1023084712DR. CHRISTOPHER FARRAR M.D.
Individual
Hospitalist6800 STATE ROUTE 162
MARYVILLE, IL 62062
(618) 288-4095
1629026877 DAVID C AUTRY MD
Individual
Radiology (Diagnostic Radiology)6800 STATE ROUTE 162 ANDERSON HOSPITAL DEPT OF RADIOLOGY
MARYVILLE, IL 62062
(618) 288-5711
1841246956MIDWEST EMERGENCY SERVICES INC
Organization
Emergency Medicine6800 STATE ROUTE 162
MARYVILLE, IL 62062
(618) 288-5711
1124062757 TERRY J BURK MD
Individual
Radiology (Diagnostic Radiology)6800 STATE ROUTE 162 ANDERSON HOSPITAL DEPT OF RADIOLOGY
MARYVILLE, IL 62062
(618) 288-5711
1033153663 THOMAS E HILL MD
Individual
Radiology (Diagnostic Radiology)6800 STATE ROUTE 162 ANDERSON HOSPITAL DEPT OF RADIOLOGY
MARYVILLE, IL 62062
(618) 288-5711
1043327554 KELLY JESTER GELDMACHER M.D.
Individual
Emergency Medicine6800 STATE ROUTE 162
MARYVILLE, IL 62062
(618) 391-5711
1689757544 KIMBERLY M. DAVID OTR
Individual
Occupational Therapist6800 STATE ROUTE 162
MARYVILLE, IL 62062
(618) 288-5711
1669539623SOUTHWESTERN ILLINOIS HEALTH FACILITY, INC
Organization
General Acute Care Hospital6800 STATE ROUTE 162
MARYVILLE, IL 62062
(618) 288-5711
1548395296 CHANDRA L HEINLEIN OT
Individual
Occupational Therapist6800 STATE ROUTE 162
MARYVILLE, IL 62062
(618) 288-5711
1720113491 MICAELA M. LILES MS,CCC-SLP
Individual
Speech-Language Pathologist6800 STATE ROUTE 162
MARYVILLE, IL 62062
(618) 288-5711
1164557831 KATRINA MCNAIR-SMITH MS,CCC-A
Individual
Audiologist6800 STATE ROUTE 162
MARYVILLE, IL 62062
(618) 288-5711
1689709347 SHARON L LAVELY PT
Individual
Physical Therapist6800 STATE ROUTE 162
MARYVILLE, IL 62062
(618) 288-5711
1841325511 JENNIFER L. MOSS OT
Individual
Occupational Therapist6800 STATE ROUTE 162
MARYVILLE, IL 62062
(618) 288-5711
1962537530 KATHRYN A. OLAND PT
Individual
Physical Therapist6800 STATE ROUTE 162
MARYVILLE, IL 62062
(618) 288-5711
1881729465 PATRICE A SCHAAKE MS, CCC-SLP
Individual
Speech-Language Pathologist6800 STATE ROUTE 162
MARYVILLE, IL 62062
(618) 288-5711
1861527442 DEE A. THIEMS PT
Individual
Physical Therapist6800 STATE ROUTE 162
MARYVILLE, IL 62062
(618) 288-5711

Frequently Asked Questions

What is Dr. Jonathan Sehy M.D., PH.D. NPI number?

The NPI number assigned to Dr. Jonathan Sehy M.D., PH.D. is 1013081942, registered as an "individual" on November 20, 2006

Where is Dr. Jonathan Sehy M.D., PH.D. located?

The provider is located at 6800 State Route 162 Anderson Hospital, Dept. Of Radiology Maryville, Il 62062 and the phone number is (314) 359-3166

Which is Dr. Jonathan Sehy M.D., PH.D. specialty?

The provider's speciality is Radiology with a focus in Diagnostic Radiology

How many years of experience does Dr. Jonathan Sehy M.D., PH.D. have?

The provider has more than 20 years of experience. He graduated from Washington University School Of Medicine in 2003.

What insurance does Dr. Jonathan Sehy M.D., PH.D. accept?

The provider might be accepting Medicaid and Medicare. Please consult your insurance carrier or call the provider to make sure your insurance plan is currently accepted.

Is Dr. Jonathan Sehy M.D., PH.D. registered in PECOS?

Yes, as of November 14, 2022 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a Medicare beneficiary 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.

How much is a visit to Dr. Jonathan Sehy M.D., PH.D.?

Medicare beneficiaries should expect a typical cost of $91.32 with an average copayment of $22.83 for new patient appointments. Established patients should expect a typical charge of $73.79 and an average copayment of 18.44. Please review your insurance plan or contact the provider directly to determine your specific costs.

What are some of the services provided by Dr. Jonathan Sehy M.D., PH.D.?

The most common procedures or services performed by this practitioner are: X-ray of chest, 2 views, front and side, X-ray of chest, 1 view, front, Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck, X-ray of abdomen, single view, CT scan of abdomen and pelvis with contrast, CT scan of abdomen and pelvis, X-ray of ribs of one side of body, minimum of 2 views, X-ray of knee, 4 or more views, Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers, Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers, X-ray of shoulder, minimum of 2 views, Nuclear medicine study of vessels of heart using drugs or exercise multiple studies, X-ray of foot, minimum of 3 views, X-ray of hand, minimum of 3 views, X-ray of wrist, minimum of 3 views, Ultrasonic guidance imaging supervision and interpretation for insertion of needle, Ultrasound of head and neck, Bone and/or joint imaging, whole body, Aspiration and/or injection of large joint or joint capsule, Nuclear medicine study with CT imaging skull base to mid-thigh, Nuclear medicine study of lung ventilation and blood circulation in the lungs, Fine needle aspiration using imaging guidance and Ultrasound study of arteries of both arms and legs.

Is Dr. Jonathan Sehy M.D., PH.D. affiliated to any hospitals?

The practitioner is affiliated to the following hospitals: ANDERSON HOSPITAL, COMMUNITY HOSPITAL OF STAUNTON, ALTON MEMORIAL HOSPITAL and GATEWAY REGIONAL MEDICAL CENTER. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

How do I update my NPI information?

The NPI record of Dr. Jonathan Sehy M.D., PH.D. was last updated on November 20, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected]
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us at: [email protected]