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JOHN J SUTTON MD
NPI 1164490025
Family Medicine in Warren, PA

Active since March 08, 2006PECOS EnrolledAccepts Medicare Assignment
93.78/100
CMS Quality Rating
103 W SAINT CLAIR ST RM 2A, WARREN, PA 16365(814) 723-1212 Get Directions Write a Review

NPPES record last updated: August 12, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About John J Sutton Md NPPES

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

JOHN J SUTTON MD (NPI 1164490025) is an individual family medicine provider in Warren, Pennsylvania, licensed in Pennsylvania (MD054007L) and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS, is affiliated with Upmc Chautauqua At Wca, and is a graduate of New York Medical College (1988).

NPPES Registry Identity

NPI1164490025
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameJOHN J SUTTONCredential: MD
Location Address103 W SAINT CLAIR ST RM 2AWarren, PA 16365-2188
Mailing Address2 W Crescent ParkWarren, PA 16365-2111 · (814) 723-3300
Phone(814) 723-1212
Sole ProprietorNo
Medical School CMSNew York Medical CollegeGraduated 1988
Enumeration DateMarch 8, 2006
Last NPPES UpdateAugust 12, 2020
NPPES CertifiedAugust 12, 2020
✔ NPI 1164490025 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in PA · MD054007L
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.
103 W SAINT CLAIR ST RM 2A, Warren, PA 16365
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Other Identifiers 1

Other529218PA · Highmark

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

John J Sutton 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 ID4587673934
PECOS Enrollment IDI20060412000298
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 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.
515 services255 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.
246 services137 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 services50 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
37 services37 patients
Transitional care management services for problem of at least moderate complexity 99495
Transitional care management services focus on coordinating and managing your care after you leave the hospital. For moderate complexity problems, this involves managing your medications, arranging further treatments, and ensuring you have the necessary follow-ups.
33 services27 patients
Aspiration and/or injection of fluid from large joint 20610
This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.
24 services21 patients

Hospital Affiliations CMS Care Compare 3

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

Upmc Chautauqua At Wca

Acute Care Hospitals · Jamestown, NY
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number330239
Location207 Foote AvenueJamestown, NY 14701 · Chautauqua County
Emergency services Birthing friendly

Warren General Hospital

Acute Care Hospitals · Warren, PA
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390146
LocationTwo Crescent Park WestWarren, PA 16365 · Warren County
Emergency services Birthing friendly

Lecom Health Corry Memorial Hospital

Critical Access Hospitals · Corry, PA
OwnershipGovernment - Hospital District or Authority
CMS Certification Number391308
Location965 Shamrock LaneCorry, PA 16407 · Erie County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 16365 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.

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.

93.78/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality85.07
Promoting Interoperability100
Improvement Activities40

Reported Quality Measures

Colorectal Cancer Screening
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
63%763 patients3/55-star benchmark: 85%
Diabetes: Medical Attention for Nephropathy
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
93%220 patients4/55-star benchmark: 99%
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.
97%3,549 patients4/55-star benchmark: 100%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
91%1,866 patients3/55-star benchmark: 99%
Health Information Exchange
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for…
5%91 patients1/55-star benchmark: 88%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
49%721 patients3/55-star benchmark: 97%
Pneumococcal Vaccination Status for Older Adults
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
61%575 patients3/55-star benchmark: 90%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
35%721 patients2/55-star benchmark: 100%
Secure Messaging
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…
2%721 patients1/55-star benchmark: 89%
View, Download, or Transmit (VDT)
At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period.
7%721 patients
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
Percentage of patients 3-17 years of age who had an outpatient visit with a Primary Care Physician (PCP) or Obstetrician/Gynecologist (OB/GYN) and who had evidence of the following during the measurement period. Three rates are reported.
98%48 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.

Referred Medical Equipment & Supplies CMS DME claims 7

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

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
5 suppliers50 claims102 services$6.16 avg. paid by Medicare
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431
DME-Oxygen and Supplies · category DC000N
3 suppliers26 claims30 services$19.88 avg. paid by Medicare
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
DME-Oxygen and Supplies · category DC002N
2 suppliers59 claims59 services$111.89 avg. paid by Medicare
Portable oxygen concentrator, rental E1392
DME-Oxygen and Supplies · category DC002N
1 supplier23 claims23 services$34.87 avg. paid by Medicare
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme J7620
DME-Drugs Administered Through DME · category DG006N
4 suppliers18 claims1,440 services$0.07 avg. paid by Medicare
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing K0738
DME-Oxygen and Supplies · category DC000N
1 supplier24 claims24 services$34.36 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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 John Sutton's NPI number?

The NPI number for John Sutton is 1164490025. It was assigned to this individual provider in the NPPES registry on March 8, 2006.

Where is John Sutton located?

John Sutton practices at 103 W Saint Clair St Rm 2A, Warren, PA 16365. The listed phone number is (814) 723-1212.

What is John Sutton's specialty?

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

Is John Sutton enrolled in Medicare?

Yes. John Sutton 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.

Is John Sutton affiliated with any hospitals?

According to CMS data, John Sutton is affiliated with Upmc Chautauqua At Wca, Warren General Hospital and Lecom Health Corry Memorial Hospital.

When was this NPI record last updated?

The NPPES record for John Sutton was last updated on August 12, 2020. 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.