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SUMESH KHANAL M.D.
NPI 1053807198
Hospitalist in Rochester, NY

Active since July 02, 2018PECOS EnrolledAccepts Medicare Assignment
95.19/100
CMS Quality Rating
1425 PORTLAND AVE, ROCHESTER, NY 14621(585) 922-5067(585) 922-2908 Get Directions Write a Review

NPPES record last updated: January 12, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 27, 2021, Jul 5, 2021, Jun 17, 2021 and 1 more (4 updates tracked since 2018).

About Sumesh Khanal M.d. NPPES

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

SUMESH KHANAL M.D. (NPI 1053807198) is an individual hospitalist provider in Rochester, New York, licensed in New York (311184) and active in the NPI registry since July 2018. He is enrolled in Medicare PECOS, is affiliated with Montefiore New Rochelle Hospital, and maintains 4 additional practice locations.

NPPES Registry Identity

NPI1053807198
Entity TypeIndividualMale
Primary Taxonomy208M00000X
Provider Legal NameSUMESH KHANALCredential: M.D.
Location Address1425 PORTLAND AVERochester, NY 14621-3011
Mailing Address100 Kings Hwy SRochester, NY 14617-5504 · (585) 922-5067 · Fax (585) 922-2908
Phone(585) 922-5067
Fax(585) 922-2908
Sole ProprietorNo
Medical School CMSOtherGraduated 2015
Enumeration DateJuly 2, 2018
Last NPPES UpdateJanuary 12, 20244 updates tracked since enumeration
NPPES CertifiedJanuary 12, 2024
✔ NPI 1053807198 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyHospitalistAllopathic & Osteopathic Physicians
Taxonomy Code208M00000X
License✔ Licensed in NY · 311184
Definition
Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients.
Also ListedInternal MedicineTaxonomy 207R00000X · License 311184 (NY)
1425 PORTLAND AVE, Rochester, NY 14621
Open in Google Maps ↗

Secondary Practice Locations 4

Location 1127 North StBatavia, NY 14020-1631 · Phone (585) 343-6030 · Fax (585) 344-7434
Location 21555 Long Pond RdRochester, NY 14626-4122 · Phone (585) 723-7870 · Fax (585) 723-7871
Location 32 Coulter RdClifton Springs, NY 14432-1122 · Phone (315) 462-1472 · Fax (315) 462-2639
Location 41200 Driving Park AveNewark, NY 14513-1090 · Phone (315) 359-2123 · Fax (315) 359-2167

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

Sumesh Khanal M.d. 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 ID5395091003
PECOS Enrollment IDI20210805003536
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

9

Medicare enrollment records show Sumesh Khanal reassigns Medicare billing to 9 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Rochester General Hospital
0.1 mi
General Acute Care Hospital
1425 PORTLAND AVE
Rochester, NY 14621
  • Reassigned Medicare billing, New York enrollment
  • 2,285 clinicians in this Medicare group
NPI 1063531929 (585) 922-4000
The Unity Hospital Of Rochester
0.9 mi
General Acute Care Hospital
100 KINGS HWY S
Rochester, NY 14617
  • Reassigned Medicare billing, New York enrollment
  • 1,442 clinicians in this Medicare group
NPI 1457395766 (585) 922-1900
Newark Wayne Community Hospital
26 mi
General Acute Care Hospital
1200 DRIVING PARK AVE
Newark, NY 14513
  • Reassigned Medicare billing, New York enrollment
  • 679 clinicians in this Medicare group
NPI 1346369212 (315) 332-2022
Clifton Springs Sanitarium Co
28 mi
General Acute Care Hospital
2 COULTER RD
Clifton Springs, NY 14432
  • Reassigned Medicare billing, New York enrollment
  • 872 clinicians in this Medicare group
NPI 1366505463 (315) 462-9561
United Memorial Medical Center
32 mi
Family Medicine
127 NORTH ST
Batavia, NY 14020
  • Reassigned Medicare billing, New York enrollment
  • 782 clinicians in this Medicare group
NPI 1669747085 (585) 343-6030
Tower Health Medical Group
212 mi
Addiction Medicine
101 WELLNESS WAY STE 210
Reading, PA 19605
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 1,473 clinicians in this Medicare group
NPI 1093266140 (484) 628-1324
Pottstown Clinic Company LLC
227 mi
Family Medicine
730 S HANOVER ST
Pottstown, PA 19465
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 474 clinicians in this Medicare group
NPI 1649341934 (610) 323-6835
Phoenixville Clinic Company LLC
231 mi
Vascular Surgery
420 W LINFIELD TRAPPE RD, STE 1100
Limerick, PA 19468
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 529 clinicians in this Medicare group
NPI 1790746345 (610) 495-2550
Montefiore New Rochelle Hospital
245 mi
General Acute Care Hospital
100 CORPORATE DR, PROVIDER INFORMATION
Yonkers, NY 10701
  • Reassigned Medicare billing, New York enrollment
  • 211 clinicians in this Medicare group
NPI 1295163244 (914) 377-4722

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.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233
Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.
312 services168 patients
Hospital discharge day management, more than 30 minutes 99239
Hospital discharge day management over 30 minutes involves a detailed process to ensure a smooth transition from hospital to home. It includes final examinations, discussion of your hospital stay, post-discharge instructions, and coordinating follow-up care.
199 services192 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
130 services81 patients
Advance care planning, first 30 minutes 99497
Advance care planning is a process where you discuss your healthcare preferences with your doctor. This conversation, lasting up to 30 minutes, helps ensure your wishes are respected if you're unable to communicate them in the future. It's about your care, your way.
22 services20 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
16 services16 patients
Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99231
Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.
16 services13 patients

Hospital Affiliations CMS Care Compare

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

Montefiore New Rochelle Hospital

Acute Care Hospitals · New Rochelle, NY
1/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number330184
Location16 Guion PlaceNew Rochelle, NY 10802 · Westchester County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 14621 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
$126.40 typical visit price
range $54.87 – $166.88
Typical copayment $31.60 (range $13.71 – $41.72)
Most-billed visit code 99204
Established Patient
$97.08 typical visit price
range $17.54 – $136.14
Typical copayment $24.27 (range $4.38 – $34.03)
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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

95.19/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality70.62
Promoting Interoperability100
Improvement Activities40

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. NIAZ AHMED D.D.S.
Dentist
1425 PORTLAND AVE
ROCHESTER, NY 14621
Monroe County (585) 922-4000
DR. BRIAN JOHN THOMAS D.O.
Anesthesiology
1425 PORTLAND AVE
ROCHESTER, NY 14621
Monroe County (585) 922-4159
LISA NICOLE FRONCZAK PA-C
Physician Assistant
1425 PORTLAND AVE, BOX 362
ROCHESTER, NY 14621
Monroe County (585) 922-4000
ANDREW ROTANDO DO
Emergency Medicine
1425 PORTLAND AVE
ROCHESTER, NY 14621
Monroe County (585) 922-3469
ALEXANDER VAZZANO MD
Emergency Medicine
1425 PORTLAND AVE
ROCHESTER, NY 14621
Monroe County (585) 922-4638
AMY BODROG MD
Internal Medicine (Hematology)
1425 PORTLAND AVE
ROCHESTER, NY 14621
Monroe County (585) 922-4020
NUMRA ASLAM BAJWA MD
Hospitalist
1425 PORTLAND AVE
ROCHESTER, NY 14621
Monroe County (585) 922-5067
DR. PRAKASH UPRETI MD
Hospitalist
1425 PORTLAND AVE
ROCHESTER, NY 14621
Monroe County (295) 029-8769

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 Sumesh Khanal's NPI number?

The NPI number for Sumesh Khanal is 1053807198. It was assigned to this individual provider in the NPPES registry on July 2, 2018.

Where is Sumesh Khanal located?

Sumesh Khanal practices at 1425 Portland Ave, Rochester, NY 14621. The listed phone number is (585) 922-5067.

What is Sumesh Khanal's specialty?

The primary specialty registered for this NPI is Hospitalist with taxonomy code 208M00000X.

Is Sumesh Khanal enrolled in Medicare?

Yes. Sumesh Khanal 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 Sumesh Khanal's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Sumesh Khanal reassigns Medicare benefits to 9 organizations: Rochester General Hospital (Rochester, NY), The Unity Hospital Of Rochester (Rochester, NY), Newark Wayne Community Hospital (Newark, NY), Clifton Springs Sanitarium Co (Clifton Springs, NY), United Memorial Medical Center (Batavia, NY) and 4 more organizations, listed in the Medicare section above. 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 Sumesh Khanal's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Sumesh Khanal affiliated with any hospitals?

According to CMS data, Sumesh Khanal is affiliated with Montefiore New Rochelle Hospital.

When was this NPI record last updated?

The NPPES record for Sumesh Khanal was last updated on January 12, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.