EDWARD R SETSER MD
NPI 1013977297
Thoracic Surgery (Cardiothoracic Vascular Surgery) in Idaho Falls, ID

NPI Status: Active since March 23, 2006

Contact Information

3200 CHANNING WAY STE A205
IDAHO FALLS, ID
ZIP 83404
Phone: (208) 535-4580
Fax: (208) 535-4520

NPI Profile Information
Primary Taxonomy
Secondary Taxonomies
Insurance Plans Accepted
Medicare Participation & PECOS Status
Areas of Expertise
Physician Visit Costs
Quality Reporting
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Male
Thoracic Surgery (Cardiothoracic Vascula...
Accepts Insurance
PECOS Enrolled
Medicare Quality Reporting

About EDWARD SETSER

This page provides the complete NPI Profile along with additional information for Edward Setser, a provider established in Idaho Falls, Idaho with a medical specialization in Thoracic Surgery (cardiothoracic Vascular Surgery). The healthcare provider is registered in the NPI registry with number 1013977297 assigned on March 2006. The practitioner's primary taxonomy code is 208G00000X with license number M12737 (ID). The provider is registered as an individual and his NPI record was last updated 4 years ago.

NPI: 1013977297
Provider Name: EDWARD R SETSER MD
Gender: Male
Entity Type: Individual
Location Address: 3200 CHANNING WAY STE A205 IDAHO FALLS, ID 83404
Location Phone: (208) 535-4580
Location Fax: (208) 535-4520
Mailing Address: PO BOX 277381 ATLANTA, GA 30384
Is Sole Proprietor?: No
Enumeration Date: 03-23-2006
Last Update Date: 07-21-2022
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Thoracic Surgery (Cardiothoracic Vascular Surgery)
Taxonomy Code: 208G00000X
Type: Allopathic & Osteopathic Physicians
License No.: M12737
License State: ID
Taxonomy Description: A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No.	Taxonomy Code	Type	Classification / Specialization	License No. (State)
1	208G00000X	Allopathic & Osteopathic Physicians	Thoracic Surgery (Cardiothoracic Vascular Surgery)	34713 (KY)

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Moda Health Plan, Inc.

Moda Select Alaska Bronze 6500 - PPO
Moda Select Alaska Bronze HDHP 5500 - PPO
Moda Select Alaska Gold 1500 - PPO
Moda Select Alaska Silver 4500 - PPO
Moda Select Alaska Standard Bronze - PPO
Moda Select Alaska Standard Gold - PPO
Moda Select Alaska Standard Silver - PPO
Moda Select Texas Bronze 8700 ($0 Virtual Urgent Care through CirrusMD) - EPO
Moda Select Texas Bronze HDHP 7500 - EPO
Moda Select Texas Standard Bronze - EPO

Providence Health Plan

HSA Qualified 7500 Bronze - Choice Network - EPO
Providence Oregon Standard Bronze Plan - Choice Network - EPO
Providence Oregon Standard Gold Plan - Choice Network - EPO
Providence Oregon Standard Silver Plan - Choice Network - EPO

Select Health

Med Benchmark Expanded Bronze Select Copay Plan - HMO
Med Benchmark Expanded Bronze Standardized Plan - HMO
Med Benchmark Gold Standardized Plan - HMO
Med Benchmark Platinum - HMO
Med Benchmark Platinum Standardized Plan - HMO
Med Benchmark Silver 6000 Medical Deductible w/Vision - HMO
Med Benchmark Silver Standardized Plan - HMO
Med Gold 1500 Medical Deductible - HMO

University of Utah Health Plans

Healthy Premier Bronze HSA - EPO
Healthy Premier Expanded Bronze Standard - EPO
Healthy Premier Gold Copay Office Visits - EPO
Healthy Premier Gold Standard - EPO
Healthy Premier Silver Copay Office Visits - EPO
Healthy Premier Silver Standard - EPO

Blue Cross Blue Shield

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

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

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State	Identifier Issuer
000023797	OTHER (01)	WV	BCBS MOUNTAIN STATE
030028200	OTHER (01)	WV	BLACK LUNG
0129142000	MEDICAID (05)	WV
0289272	MEDICAID (05)	OH
550357050	OTHER (01)	WV	UNITED MINE WORKERS
64942469	MEDICAID (05)	KY

Medicare Participation & PECOS Enrollment Status

Edward Setser 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: Durable Medical Equipment (DME) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

Is the provider registered in PECOS? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: No
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): No
Eligible to Order or Refer Power Mobility Devices: Yes

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Established patient office or other outpatient visit, 10-19 minutes
New patient office or other outpatient visit, 45-59 minutes

Physician Visit Costs

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 83404 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99205

Average New Patient Price $160.17
Minimum New Patient Price $52.44
Maximum New Patient Price $160.17

Average New Patient Copayment $40.04
Minimum New Patient Copayment $13.11
Maximum New Patient Copayment $40.04

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

Average Established Patient Price $65.77
Minimum Established Patient Price $16.68
Maximum Established Patient Price $130.93

Average Established Patient Copayment $16.44
Minimum Established Patient Copayment $4.17
Maximum Established Patient Copayment $32.73

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

Quality Reporting

The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

Quality Measure	Performance	Number of Patients
Closing the Referral Loop: Receipt of Specialist Report	3%	35
Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred
Documentation of Current Medications in the Medical Record	77%	744
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
Falls: Screening for Future Fall Risk	96%	219
Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period
Implementation of fall screening and assessment programs	Yes	N/A
Implementation of fall screening and assessment programs to identify patients at risk for falls and address modifiable risk factors (e.g., Clinical decision support/prompts in the electronic health record that help manage the use of medications, such as benzodiazepines, that increase fall risk).
Implementation of medication management practice improvements	Yes	N/A
Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/or Conduct periodic, structured medication reviews.
Medication Reconciliation	100%	39
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
Participation in an AHRQ-listed patient safety organization.	Yes	N/A
Participation in an AHRQ-listed patient safety organization.
Patient Centered Surgical Risk Assessment and Communication for Cardiac Surgery	100%	43
Percentage of patients age 18 and older undergoing a non-emergency risk modeled cardiac surgery procedure that had personalized risk assessment using the STS risk calculator and discussed those risks with the surgeon.
Patient-Specific Education	52%	92
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
Pneumococcal Vaccination Status for Older Adults	1%	226
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan	93%	308
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 encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2
Preventive Care and Screening: Screening for Depression and Follow-Up Plan	1%	308
Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	98%	53
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Provide Patient Access	100%	92
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information.
Secure Messaging	3%	92
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period.
Security Risk Analysis	Yes	N/A
Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.
Specialized Registry Reporting	Yes	N/A
The MIPS eligible clinician is in active engagement to submit data to specialized registry. To earn a 5 % bonus in the promoting interoperability performance category score for submitting to one or more public health or clinical data registries also attest to PI_TRANS_PHCDRR_3_MULTI.
Use of decision support and standardized treatment protocols	Yes	N/A
Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs.
Use of High-Risk Medications in the Elderly	0% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better.	216
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication. 2) Percentage of patients who were ordered at least two of the same high-risk medication

NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1013977297, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 63. The final step is to find the difference between that total and the next multiple of ten (70 - 63 = 7).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 2

Pos 4

Unchanged

Pos 5

Doubled → 18 → 1 + 8

Pos 6

Unchanged

Pos 7

Doubled → 14 → 1 + 4

Pos 8

Unchanged

Pos 9

Doubled → 18 → 1 + 8

Check

Target digit

Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 1 → 2 9 → 18 → 9 7 → 14 → 5 9 → 18 → 9

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 0 + 2 + 3 + 1 + 8 + 7 + 1 + 4 + 2 + 1 + 8 + 24 = 63

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 63 is 70. The difference is the calculated check digit.

70 - 63 = 7

This NPI is valid

The calculated check digit is 7, which matches the last digit of 1013977297.