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DR. JAMES PRIETO MD
NPI 1154580769
Colon & Rectal Surgery in San Antonio, TX

Active since June 09, 2008PECOS EnrolledAccepts Medicare Assignment
100/100
CMS Quality Rating
5510-B PRESIDIO PARKWAY, SUITE 2206, SAN ANTONIO, TX 78249(210) 874-3640(210) 874-3649 Get Directions Write a Review

NPPES record last updated: July 5, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. James Prieto Md NPPES

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

DR. JAMES PRIETO MD (NPI 1154580769) is an individual colon & rectal surgery provider in San Antonio, Texas, licensed in Texas (N4001) and active in the NPI registry since June 2008. He is enrolled in Medicare PECOS, is affiliated with Baptist Medical Center, and is a graduate of University Of Miami, Lm Miller School Of Medicine (2003).

NPPES Registry Identity

NPI1154580769
Entity TypeIndividualMale
Primary Taxonomy208C00000X
Provider Legal NameDR. JAMES PRIETOCredential: MD
Location Address5510-B PRESIDIO PARKWAY, SUITE 2206San Antonio, TX 78249
Mailing Address5510-b Presidio Parkway, Suite 2206San Antonio, TX 78249 · (210) 874-3640 · Fax (210) 874-3649
Phone(210) 874-3640
Fax(210) 874-3649
Sole ProprietorYes
Medical School CMSUniversity Of Miami, Lm Miller School Of MedicineGraduated 2003
Enumeration DateJune 9, 2008
Last NPPES UpdateJuly 5, 2022
NPPES CertifiedJuly 5, 2022
✔ NPI 1154580769 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyColon & Rectal SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208C00000X
License✔ Licensed in TX · N4001
Definition
A colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by medical and surgical means. This specialist also deals with other organs and tissues (such as the liver, urinary and female reproductive system) involved with primary intestinal disease.
Also ListedSurgeryTaxonomy 208600000X · License ME 101254 (FL)
5510-B PRESIDIO PARKWAY, San Antonio, TX 78249
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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, Molina Healthcare, Oscar Insurance Company.Insurance ›

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

Dr. James Prieto 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 ID4789739889
PECOS Enrollment IDI20090825000547
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 8

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.

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
122 services73 patients
New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205
This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.
62 services62 patients
Diagnostic exam of anus using an endoscope 46600
This procedure involves using a thin, flexible instrument called an endoscope to examine the anal area. It helps detect any abnormal conditions or issues. It's a safe, routine exam performed by a healthcare professional.
53 services49 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.
53 services38 patients
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.
52 services27 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.
39 services34 patients

Hospital Affiliations CMS Care Compare 3

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

Baptist Medical Center

Acute Care Hospitals · San Antonio, TX
4/5 CMS rating
OwnershipProprietary
CMS Certification Number450058
Location111 Dallas StreetSan Antonio, TX 78205 · Bexar County
Emergency services Birthing friendly

Methodist Hospital

Acute Care Hospitals · San Antonio, TX
4/5 CMS rating
OwnershipProprietary
CMS Certification Number450388
Location7700 Floyd Curl DrSan Antonio, TX 78229 · Bexar County
Emergency services Birthing friendly

Methodist Hospital Stone Oak

Acute Care Hospitals · San Antonio, TX
4/5 CMS rating
OwnershipProprietary
CMS Certification Number670055
Location1139 E Sonterra Blvd,San Antonio, TX 78258 · Bexar County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 78249 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
$84.92 typical visit price
range $54.84 – $166.88
Typical copayment $21.23 (range $13.71 – $41.72)
Most-billed visit code 99203
Established Patient
$68.55 typical visit price
range $17.52 – $136.11
Typical copayment $17.13 (range $4.38 – $34.02)
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.

100/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Promoting Interoperability100
Improvement Activities40

Referred Medical Equipment & Supplies CMS DME claims 4

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce A4394
DME-Orthotic Devices · category DF010N
4 suppliers16 claims211 services$2.50 avg. paid by Medicare
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each A4409
DME-Orthotic Devices · category DF010N
2 suppliers12 claims320 services$5.63 avg. paid by Medicare
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each A4425
DME-Orthotic Devices · category DF010N
4 suppliers22 claims570 services$3.17 avg. paid by Medicare
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each A5057
DME-Orthotic Devices · category DF010N
3 suppliers12 claims1,005 services$9.29 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

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

GUILLERMO MEDRANO DEL ROSAL M.D.
Surgery
5510-B PRESIDIO PARKWAY, SUITE 2205
SAN ANTONIO, TX 78249
Bexar County (210) 874-3732

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 James Prieto's NPI number?

The NPI number for James Prieto is 1154580769. It was assigned to this individual provider in the NPPES registry on June 9, 2008.

Where is James Prieto located?

James Prieto practices at 5510-B Presidio Parkway Suite 2206, San Antonio, TX 78249. The listed phone number is (210) 874-3640.

What is James Prieto's specialty?

The primary specialty registered for this NPI is Colon & Rectal Surgery with taxonomy code 208C00000X.

Is James Prieto enrolled in Medicare?

Yes. James Prieto 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.

What insurance does James Prieto accept?

Health plans from Blue Cross and Blue Shield of Texas, Molina Healthcare and Oscar Insurance Company list James Prieto 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 James Prieto affiliated with any hospitals?

According to CMS data, James Prieto is affiliated with Baptist Medical Center, Methodist Hospital and Methodist Hospital Stone Oak.

When was this NPI record last updated?

The NPPES record for James Prieto was last updated on July 5, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.