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SUSHIL S. MODY MD
NPI 1164481891
Pediatrics in E Stroudsburg, PA

Active since March 21, 2006PECOS Enrolled
175 E BROWN ST, SUITE 108, E STROUDSBURG, PA 18301(570) 476-3585(570) 421-9014 Get Directions Write a Review

NPPES record last updated: February 29, 2012. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Sushil S. Mody Md NPPES

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

SUSHIL S. MODY MD (NPI 1164481891) is an individual pediatrics provider in E Stroudsburg, Pennsylvania, licensed in Pennsylvania (MD422414) and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1164481891
Entity TypeIndividualMale
Primary Taxonomy208000000X
Provider Legal NameSUSHIL S. MODYCredential: MD
Location Address175 E BROWN ST, SUITE 108E Stroudsburg, PA 18301-3098
Mailing Address5545 Bridle RdStroudsburg, PA 18360-9197 · (570) 793-3254 · Fax (866) 471-3154
Phone(570) 476-3585
Fax(570) 421-9014
Sole ProprietorNo
Enumeration DateMarch 21, 2006
Last NPPES UpdateFebruary 29, 2012
✔ NPI 1164481891 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in PA · MD422414
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
175 E BROWN ST, E Stroudsburg, PA 18301
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Other Identifiers 2

Medicaid1009422450002PA
Medicare UPINI05198PA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter Health, Ambetter Health of Delaware.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Sushil S. Mody Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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

3

Medicare enrollment records show Sushil Mody reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Family Care Centers Inc
0.5 mi
Family Medicine
200 E BROWN ST
East Stroudsburg, PA 18301
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 500 clinicians in this Medicare group
NPI 1316409626 (570) 476-3700
Lehigh Valley Physician Group
0.5 mi
Family Medicine
200 E BROWN ST
East Stroudsburg, PA 18301
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 2,895 clinicians in this Medicare group
NPI 1366236937 (272) 762-4378
Valley Health Partners Community Health Center
1.5 mi
Federally Qualified Health Center (FQHC)
500 PLAZA CT
East Stroudsburg, PA 18301
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 296 clinicians in this Medicare group
NPI 1689409419 (570) 476-3585

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 18301 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
$84.88 typical visit price
range $54.64 – $166.87
Typical copayment $21.22 (range $13.66 – $41.71)
Most-billed visit code 99203
Established Patient
$96.82 typical visit price
range $17.33 – $135.84
Typical copayment $24.20 (range $4.33 – $33.96)
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.

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. THOMAS MICHAEL PAPA MD
Internal Medicine (Infectious Disease)
175 E BROWN ST, SUITE 114
EAST STROUDSBURG, PA 18301
Monroe County (570) 426-2301
MS. CAROL STANEK CRNP
Nurse Practitioner (Family)
175 E BROWN ST
EAST STROUDSBURG, PA 18301
Monroe County (570) 420-6450
SUSHEER GANDOTRA M.D.
Internal Medicine (Infectious Disease)
175 E BROWN ST, SUITE 114
EAST STROUDSBURG, PA 18301
Monroe County (570) 426-2301
DR. SHANDURAI TEURAI TAKAVARASHA M.D.
Internal Medicine (Infectious Disease)
175 E BROWN ST
EAST STROUDSBURG, PA 18301
Monroe County (570) 426-2840
POCONO ORTHOPAEDICS SURGERY
Orthopaedic Surgery
175 E BROWN ST, SUITE 114
EAST STROUDSBURG, PA 18301
Monroe County (570) 426-2301
KIMBERLY DOWNES DO
Pediatrics
175 E BROWN ST
EAST STROUDSBURG, PA 18301
Monroe County (570) 476-3585
DR. JOSE R BORDAS M.D.
Pediatrics
175 E BROWN ST, SUITE 108
EAST STROUDSBURG, PA 18301
Monroe County (570) 476-3585
PHILIP H. LAWRENCE MD
Obstetrics & Gynecology
175 E BROWN ST, POCONO OBSTETRICS AND GYNECOLOGY, SUITE 113
EAST STROUDSBURG, PA 18301
Monroe County (570) 421-3401

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 Sushil Mody's NPI number?

The NPI number for Sushil Mody is 1164481891. It was assigned to this individual provider in the NPPES registry on March 21, 2006.

Where is Sushil Mody located?

Sushil Mody practices at 175 E Brown St Suite 108, E Stroudsburg, PA 18301. The listed phone number is (570) 476-3585.

What is Sushil Mody's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Sushil Mody enrolled in Medicare?

Yes. Sushil Mody is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Sushil Mody's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Sushil Mody reassigns Medicare benefits to 3 organizations: Family Care Centers Inc (East Stroudsburg, PA), Lehigh Valley Physician Group (East Stroudsburg, PA) and Valley Health Partners Community Health Center (East Stroudsburg, PA). 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 Sushil Mody's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Sushil Mody accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Ambetter from Buckeye Health Plan list Sushil Mody 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 Sushil Mody was last updated on February 29, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.