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DR. SEAN SUTPHEN DO
NPI 1124648696
Family Medicine in Le Mars, IA

Active since April 24, 2020PECOS EnrolledAccepts Medicare Assignment
93.71/100
CMS Quality Rating
714 LINCOLN ST NE, LE MARS, IA 51031(712) 546-3677(712) 546-3690 Get Directions Write a Review

NPPES record last updated: September 6, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Sep 6, 2024, Oct 18, 2023, Apr 24, 2020 (3 updates tracked since 2020).

About Dr. Sean Sutphen Do NPPES

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

DR. SEAN SUTPHEN DO (NPI 1124648696) is an individual family medicine provider in Le Mars, Iowa, licensed in Virginia (0102207523) and active in the NPI registry since April 2020. He is enrolled in Medicare PECOS, is affiliated with St Lukes Regional Medical Center, and maintains 6 additional practice locations.

NPPES Registry Identity

NPI1124648696
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameDR. SEAN SUTPHENCredential: DO
Location Address714 LINCOLN ST NELe Mars, IA 51031-3311
Mailing Address209 4th Ave NwLe Mars, IA 51031-3136 · (703) 939-1207
Phone(712) 546-3677
Fax(712) 546-3690
Sole ProprietorNo
Medical School CMSOtherGraduated 2020
Enumeration DateApril 24, 2020
Last NPPES UpdateSeptember 6, 20243 updates tracked since enumeration
NPPES CertifiedSeptember 6, 2024
✔ NPI 1124648696 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in VA · 0102207523
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
714 LINCOLN ST NE, Le Mars, IA 51031
Open in Google Maps ↗

Secondary Practice Locations 6

Location 1607 E Jubal Early DrWinchester, VA 22601-5178 · Phone (540) 536-2232 · Fax (540) 536-2206
Location 2160 Merchant St Ste 200Winchester, VA 22603-4772 · Phone (540) 536-5950 · Fax (540) 536-5955
Location 365 Riverton Commons DrFront Royal, VA 22630-6768 · Phone (154) 063-5070
Location 4415A South StFront Royal, VA 22630-2115 · Phone (540) 636-0495 · Fax (540) 636-0450
Location 533820 Old Valley Pike Ste 2Strasburg, VA 22657-3793 · Phone (540) 459-1310 · Fax (540) 459-1311
Location 65301 Main StMount Jackson, VA 22842-9649 · Phone (540) 459-1250 · Fax (540) 459-1251

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource, Oscar Insurance Company, Wellmark Health Plan of Iowa, Inc..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

Dr. Sean Sutphen Do 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 ID5092137703
PECOS Enrollment IDI20231219003820
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

2

Medicare enrollment records show Sean Sutphen reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Floyd Valley Healthcare
Same address
Critical Access
714 LINCOLN ST NE
Le Mars, IA 51031
  • Reassigned Medicare billing, Iowa enrollment
  • Also billed through NPI 1104988294 (Iowa)
  • 40 clinicians in this Medicare group
NPI 1326109315 (712) 546-7871
Valley Regional Enterprises, Inc
967 mi
Urgent Care
33820 OLD VALLEY PIKE, SUITE 2
Strasburg, VA 22657
  • Reassigned Medicare billing, Virginia enrollment
  • 77 clinicians in this Medicare group
NPI 1063666196 (540) 536-2221

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 3

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 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.
29 services19 patients
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
24 services23 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.
14 services12 patients

Hospital Affiliations CMS Care Compare 3

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

St Lukes Regional Medical Center

Acute Care Hospitals · Sioux City, IA
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number160146
Location2720 Stone Park BoulevardSioux City, IA 51104 · Woodbury County
Emergency services Birthing friendly

Floyd Valley Healthcare

Critical Access Hospitals · Le Mars, IA
OwnershipGovernment - Local
CMS Certification Number161368
Location714 Lincoln St NELe Mars, IA 51031 · Plymouth County
Emergency services Birthing friendly

Avera Mckennan Hospital & University Health Center

Acute Care Hospitals · Sioux Falls, SD
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number430016
Location1325 S Cliff AveSioux Falls, SD 57117 · Minnehaha County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 51031 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
$81.84 typical visit price
range $52.96 – $161.40
Typical copayment $20.46 (range $13.24 – $40.35)
Most-billed visit code 99203
Established Patient
$94.05 typical visit price
range $16.91 – $131.98
Typical copayment $23.51 (range $4.22 – $32.99)
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.

93.71/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality88.72
Promoting Interoperability97.84
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.

MRS. GERI L SCHROEDER ARNP
Nurse Practitioner
714 LINCOLN ST NE
LE MARS, IA 51031
Plymouth County (712) 546-3398
DR. SHEILA RAE HOLCOMB M.D.
Family Medicine
714 LINCOLN ST NE
LE MARS, IA 51031
Plymouth County (712) 546-3630
STELZER SURGERY, PC
General Practice
714 LINCOLN ST NE
LE MARS, IA 51031
Plymouth County (712) 546-8744
FLOYD VALLEY HEALTHCARE
Medicare Defined Swing Bed Unit
714 LINCOLN ST NE
LE MARS, IA 51031
Plymouth County (712) 546-7871
DR. STEVEN JOSEPH MEIS M.D.
Family Medicine
714 LINCOLN ST NE
LE MARS, IA 51031
Plymouth County (712) 546-3660
DR. HEIDI MILLER DO
Family Medicine
714 LINCOLN ST NE
LE MARS, IA 51031
Plymouth County (712) 546-7871
KAY LYNN KOSTERS PA-C
Physician Assistant (Medical)
714 LINCOLN ST NE
LE MARS, IA 51031
Plymouth County (712) 546-3650
MRS. CONNIE D HANSON SP
Speech-Language Pathologist
714 LINCOLN ST NE
LE MARS, IA 51031
Plymouth County (712) 546-3398

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 Sutphen's NPI number?

The NPI number for Sean Sutphen is 1124648696. It was assigned to this individual provider in the NPPES registry on April 24, 2020.

Where is Sean Sutphen located?

Sean Sutphen practices at 714 Lincoln St NE, Le Mars, IA 51031. The listed phone number is (712) 546-3677.

What is Sean Sutphen's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Sean Sutphen enrolled in Medicare?

Yes. Sean Sutphen 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 Sean Sutphen's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Sean Sutphen reassigns Medicare benefits to 2 organizations: Floyd Valley Healthcare (Le Mars, IA) and Valley Regional Enterprises, Inc (Strasburg, VA). 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 Sean Sutphen's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Sean Sutphen accept?

Health plans from CareSource, Oscar Insurance Company and Wellmark Health Plan of Iowa, Inc. list Sean Sutphen 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.

Is Sean Sutphen affiliated with any hospitals?

According to CMS data, Sean Sutphen is affiliated with St Lukes Regional Medical Center, Floyd Valley Healthcare and Avera Mckennan Hospital & University Health Center.

When was this NPI record last updated?

The NPPES record for Sean Sutphen was last updated on September 6, 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.