GAVIN SETZEN MD
NPI 1063419232
Otolaryngology in Albany, NY

Q: What is Gavin Setzen's NPI number?

The NPI number for Gavin Setzen is 1063419232. It was assigned to this individual provider in the NPPES registry on July 3, 2005.

Q: What is Gavin Setzen's specialty?

The primary specialty registered for this NPI is Otolaryngology with taxonomy code 207Y00000X.

Q: When was this NPI record last updated?

The NPPES record for Gavin Setzen was last updated on October 3, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.

Active since July 03, 2005PECOS EnrolledAccepts Medicare Assignment

80.78/100

CMS Quality Rating

123 EVERETT RD, ALBANY, NY 12205(518) 701-2000(518) 701-2020 Get Directions Write a Review

NPPES record last updated: October 3, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Gavin Setzen Md NPPES

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

GAVIN SETZEN MD (NPI 1063419232) is an individual otolaryngology provider in Albany, New York, licensed in New York (191506) and active in the NPI registry since July 2005. He is enrolled in Medicare PECOS, is affiliated with St Peter's Hospital, and is a graduate of Other (1987).

NPPES Registry Identity

NPI1063419232

Entity TypeIndividualMale

Primary Taxonomy207Y00000X

Provider Legal NameGAVIN SETZENCredential: MD

Location Address123 EVERETT RDAlbany, NY 12205-1407

Mailing Address123 Everett RdAlbany, NY 12205-1407 · (518) 701-2000 · Fax (518) 701-2020

Phone(518) 701-2000

Fax(518) 701-2020

Sole ProprietorNo

Medical School CMSOtherGraduated 1987

Enumeration DateJuly 3, 2005

Last NPPES UpdateOctober 3, 2019

✔ NPI 1063419232 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyOtolaryngologyAllopathic & Osteopathic Physicians

Taxonomy Code207Y00000X

License✔ Licensed in NY · 191506

Definition

An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.

Also ListedOtolaryngology · Facial Plastic SurgeryTaxonomy 207YS0123X · License 1915061 (NY)

123 EVERETT RD, Albany, NY 12205

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Other Identifiers 1

OtherP00151895NY · Rr Medicare

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Gavin Setzen 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 ID8921086083

PECOS Enrollment IDI20040824001485

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.

Areas of Expertise CMS Part B claims 15

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.

Professional service for preparation and provision of 1 or more antigens 95165

This service involves the creation and supply of antigens, substances that stimulate your immune system to fight diseases. These antigens can be used in vaccines or allergy tests to help your body build defenses against specific health threats.

2,813 services75 patients

Professional service for multiple injections of allergen 95117

The professional service for multiple injections of allergens involves administering small doses of specific allergens into your body. This is done to help your immune system become less sensitive to them, reducing your allergic reaction over time. It's a safe, effective way to manage allergies.

1,506 services87 patients

Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml Q9967

Low osmolar contrast material with 300-399 mg/ml iodine concentration is a diagnostic tool used in imaging procedures. It helps to enhance the visibility of specific areas in the body, aiding in accurate diagnosis. It's safe and generally well-tolerated by patients.

1,380 services17 patients

Test for allergy using allergenic extract 95004

An allergy test with allergenic extract is a diagnostic method to identify substances causing allergic reactions. Small amounts of common allergens are introduced to your body, usually through skin pricks or blood tests. Your body's response helps determine your allergies.

1,239 services26 patients

Test for allergy using allergenic extract injected into skin 95024

An allergy skin test involves injecting a small amount of allergenic extract into your skin. This test helps determine if you're allergic to specific substances. If allergic, a small red bump appears at the test site. It's safe and quick.

655 services27 patients

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.

466 services410 patients

Diagnostic exam of voice box using a flexible endoscope 31575

This procedure involves a doctor examining your voice box using a flexible endoscope, a thin tube with a light and camera. It's inserted through your nose or mouth to visualize your throat area. It helps detect any abnormalities in your voice box, ensuring optimal vocal health.

156 services145 patients

Diagnostic exam of nasal passages using an endoscope 31231

A diagnostic exam of nasal passages using an endoscope is a non-invasive procedure. A small, flexible tube with a light and camera at the end, called an endoscope, is inserted into the nose. This allows the doctor to view the nasal passages and sinuses, helping to identify any issues.

142 services126 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

61 services61 patients

Removal of impacted ear wax 69210

Impacted ear wax removal is a safe procedure to clear blockages in the ear canal caused by hardened ear wax. A healthcare professional uses specialized tools or a gentle irrigation method to loosen and remove the wax, improving hearing and alleviating discomfort.

39 services32 patients

Ct guidance for needle or tube localization 77011

CT guidance for needle or tube localization is a procedure where a CT scan is used to accurately position a needle or tube within the body. It helps in diagnosing or treating conditions by ensuring precise placement for procedures such as biopsies or drainages.

35 services35 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.

33 services30 patients

Ct scan of face without contrast 70486

A CT scan of the face without contrast is a non-invasive imaging procedure. It uses X-rays to create detailed pictures of your face, including bones, soft tissues, and blood vessels. It's often used to diagnose diseases, injuries, or abnormalities. No contrast dye is used in this procedure.

18 services18 patients

Exam to assess movement of vocal cord flaps using an endoscope 31579

This procedure involves using a thin, flexible tube called an endoscope to view your vocal cords. The endoscope is gently inserted through your nose or mouth to observe the movement of your vocal cords. This helps identify any abnormalities or issues.

16 services16 patients

Ct scan of soft tissue of neck with contrast 70491

A CT scan of the neck with contrast is a non-invasive imaging procedure. A special dye is administered to highlight the soft tissues in your neck, making them easier to see. This helps detect issues like infections, tumors, or other abnormalities.

14 services14 patients

Hospital Affiliations CMS Care Compare 2

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

St Peter's Hospital

Acute Care Hospitals · Albany, NY

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number330057

Location315 South Manning BoulevardAlbany, NY 12208 · Albany County

Emergency services Birthing friendly

Samaritan Hospital Of Troy, New York

Acute Care Hospitals · Troy, NY

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number330180

Location2215 Burdett AvenueTroy, NY 12180 · Rensselaer County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 12205 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

$68.57 typical visit price

range $17.54 – $136.14

Typical copayment $17.14 (range $4.38 – $34.03)

Most-billed visit code 99213

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.

80.78/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

74.61

Promoting Interoperability

Improvement Activities

Cost

Referred Medical Equipment & Supplies CMS DME claims 14

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

5 suppliers20 claims20 services$29.86 avg. paid by Medicare

Full face mask used with positive airway pressure device, each A7030

DME-Other DME · category DE001N

6 suppliers25 claims25 services$87.57 avg. paid by Medicare

Face mask interface, replacement for full face mask, each A7031

DME-Other DME · category DE001N

5 suppliers19 claims52 services$31.58 avg. paid by Medicare

Cushion for use on nasal mask interface, replacement only, each A7032

DME-Other DME · category DE001N

6 suppliers61 claims355 services$16.29 avg. paid by Medicare

Pillow for use on nasal cannula type interface, replacement only, pair A7033

DME-Other DME · category DE001N

7 suppliers29 claims171 services$14.99 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

7 suppliers91 claims91 services$47.74 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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.

ADRIENNE E COBLE PA

Physician Assistant