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SEAN PAUL MD
NPI 1063733137
Ophthalmology in Austin, TX

Active since June 11, 2010PECOS EnrolledAccepts Medicare Assignment
4316 JAMES CASEY ST, BLDG F STE 201, AUSTIN, TX 78745(512) 642-5050(512) 642-8186 Get Directions Write a Review

NPPES record last updated: August 17, 2016. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Sean Paul Md NPPES

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

SEAN PAUL MD (NPI 1063733137) is an individual ophthalmology provider in Austin, Texas, licensed in Texas (Q2823) and active in the NPI registry since June 2010. He is enrolled in Medicare PECOS and is a graduate of University Of Texas Medical School At San Antonio (2009).

NPPES Registry Identity

NPI1063733137
Entity TypeIndividualMale
Primary Taxonomy207W00000X
Provider Legal NameSEAN PAULCredential: MD
Location Address4316 JAMES CASEY ST, BLDG F STE 201Austin, TX 78745-1116
Mailing Address4316 James Casey St, Bldg F Ste 201Austin, TX 78745-1116 · (512) 642-5050 · Fax (512) 642-8186
Phone(512) 642-5050
Fax(512) 642-8186
Sole ProprietorNo
Medical School CMSUniversity Of Texas Medical School At San AntonioGraduated 2009
Enumeration DateJune 11, 2010
Last NPPES UpdateAugust 17, 2016
✔ NPI 1063733137 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOphthalmologyAllopathic & Osteopathic Physicians
Taxonomy Code207W00000X
License✔ Licensed in TX · Q2823
Definition
An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.
4316 JAMES CASEY ST, Austin, TX 78745
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas, Harbor Health, Moda Health Plan, Inc. and more.Insurance ›

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

Sean Paul 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 ID7810130796
PECOS Enrollment IDI20150629001730
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 Reassignment

Medicare enrollment records show Sean Paul reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Austin Oculoplastics PLLC
6.6 mi
Ophthalmic Plastic and Reconstructive Surgery
7004 BEE CAVES RD STE 100
West Lake Hills, TX 78746
  • Reassigned Medicare billing, Texas enrollment
  • 6 clinicians in this Medicare group
NPI 1871982017 (512) 642-5050

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.

Photography of content of eyes 92285
Photography of the content of eyes, also known as ocular photography, captures detailed images of different parts of the eye. It helps identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. The process is non-invasive and painless.
35 services34 patients
Exam of visual field with limited testing 92081
An exam of the visual field with limited testing is a quick check of your peripheral vision. It involves identifying objects or movements at the edge of your sight, helping to detect any vision loss that isn't obvious, such as blind spots or areas of reduced vision.
34 services33 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.
32 services32 patients
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203
This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
30 services30 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.
20 services18 patients
Removal of excessive skin and fat of upper eyelid 15823
This procedure, also known as upper eyelid surgery, is performed to remove excess skin and fat from the upper eyelid. It can help improve vision if heavy eyelids hinder it, and can also enhance the appearance of the eyes. It's a common, safe procedure.
16 services16 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 78745 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
$131.95 typical visit price
range $57.88 – $174.00
Typical copayment $32.98 (range $14.47 – $43.50)
Most-billed visit code 99204
Established Patient
$71.95 typical visit price
range $18.88 – $142.23
Typical copayment $17.98 (range $4.72 – $35.55)
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.

Reported Quality Measures

Care Plan
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker…
2%522 patients1/55-star benchmark: 100%
Documentation of Current Medications in the Medical Record
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.
2%2,816 patients1/55-star benchmark: 100%
Pneumococcal Vaccination Status for Older Adults
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
4%522 patients1/55-star benchmark: 95%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
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
23%31 patients1/55-star benchmark: 100%
Tobacco Use and Help with Quitting Among Adolescents
The percentage of adolescents 12 to 20 years of age with a primary care visit during the measurement year for whom tobacco use status was documented and received help with quitting if identified as a tobacco user
24%38 patients
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

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.

ROBERT OBRIEN M.D.
Family Medicine
4316 JAMES CASEY ST, BLDG F200
AUSTIN, TX 78745
Travis County (512) 791-7555
JESSICA ANNE BROWN FNP
Nurse Practitioner (Family)
4316 JAMES CASEY ST
AUSTIN, TX 78745
Travis County (512) 623-5300
PAUL ANTHONY TUCKER II M.D.
Internal Medicine (Interventional Cardiology)
4316 JAMES CASEY ST, BUILDING C
AUSTIN, TX 78745
Travis County (512) 623-5300
GERALD VILLAREAL LEVY M.D.
Internal Medicine (Interventional Cardiology)
4316 JAMES CASEY ST, BUILDING C
AUSTIN, TX 78745
Travis County (512) 623-5300
DIPTI ASHMITA SCHRAEGLE APRN
Clinical Nurse Specialist (Adult Health)
4316 JAMES CASEY ST
AUSTIN, TX 78745
Travis County (512) 623-5300
IMAGING PARTNERS OF AUSTIN LLC
Clinic/Center (Radiology)
4316 JAMES CASEY ST, F-110B
AUSTIN, TX 78745
Travis County (512) 444-8900
IMAGING PARTNERS OF AUSTIN LLC
Clinic/Center (Radiology)
4316 JAMES CASEY ST, SUITE F110-B
AUSTIN, TX 78745
Travis County (512) 448-3127
GARY MARTIN MAILMAN MD
Emergency Medicine (Undersea and Hyperbaric Medicine)
4316 JAMES CASEY ST, SUITE B 100
AUSTIN, TX 78745
Travis County (512) 306-1903

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 Sean Paul's NPI number?

The NPI number for Sean Paul is 1063733137. It was assigned to this individual provider in the NPPES registry on June 11, 2010.

Where is Sean Paul located?

Sean Paul practices at 4316 James Casey St Bldg F Ste 201, Austin, TX 78745. The listed phone number is (512) 642-5050.

What is Sean Paul's specialty?

The primary specialty registered for this NPI is Ophthalmology with taxonomy code 207W00000X.

Is Sean Paul enrolled in Medicare?

Yes. Sean Paul 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 organization bills Medicare for Sean Paul's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Sean Paul reassigns Medicare benefits to Austin Oculoplastics PLLC (West Lake Hills, TX). The 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 Sean Paul's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Sean Paul accept?

Health plans from Blue Cross and Blue Shield of Texas, Harbor Health, Moda Health Plan, Inc., Oscar Insurance Company and Sendero Health Plans, Local Nonprofit list Sean Paul as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Sean Paul was last updated on August 17, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.