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DR. ROY D. SETTERGREN M.D.
NPI 1194055863
Hospitalist in Hinsdale, IL

Active since January 02, 2010PECOS EnrolledAccepts Medicare Assignment
75.25/100
CMS Quality Rating
120 N OAK ST, HINSDALE, IL 60521(630) 856-9000 Get Directions Write a Review

NPPES record last updated: October 13, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 20, 2021, Jun 30, 2021, Mar 5, 2019 and 1 more (4 updates tracked since 2018).

About Dr. Roy D. Settergren M.d. NPPES

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

DR. ROY D. SETTERGREN M.D. (NPI 1194055863) is an individual hospitalist provider in Hinsdale, Illinois, licensed in Illinois (036153573) and active in the NPI registry since January 2010. He is enrolled in Medicare PECOS, is affiliated with Edward Hospital, and is a graduate of Other (2009).

NPPES Registry Identity

NPI1194055863
Entity TypeIndividualMale
Primary Taxonomy208M00000X
Provider Legal NameDR. ROY D. SETTERGRENCredential: M.D.
Location Address120 N OAK STHinsdale, IL 60521-3829
Mailing Address120 N Oak StHinsdale, IL 60521-3829 · (630) 856-9000
Phone(630) 856-9000
Sole ProprietorNo
Medical School CMSOtherGraduated 2009
Enumeration DateJanuary 2, 2010
Last NPPES UpdateOctober 13, 20254 updates tracked since enumeration
NPPES CertifiedOctober 13, 2025
✔ NPI 1194055863 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyHospitalistAllopathic & Osteopathic Physicians
Taxonomy Code208M00000X
Licenses✔ Licensed in IL · 036153573✔ Licensed in WI · 75081-20
Definition
Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients.
120 N OAK ST, Hinsdale, IL 60521
Open in Google Maps ↗

Other Identifiers 2

Other036-153573IL · State License
Medicaid100165664WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Oscar Health.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. Roy D. Settergren M.d. 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 ID4880872332
PECOS Enrollment IDI20220310002814
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 Roy Settergren reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Advance Inpatient Medicine LLC
2.4 mi
Hospitalist
903 COMMERCE DRIVE, SUITE 333
Oak Brook, IL 60523
  • Reassigned Medicare billing, Illinois enrollment
  • 63 clinicians in this Medicare group
NPI 1265989875 (630) 571-6770
Knd Development 59 LLC
6.2 mi
Hospitalist
365 E NORTH AVE
Northlake, IL 60164
  • Reassigned Medicare billing, Illinois enrollment
  • 122 clinicians in this Medicare group
NPI 1598094906 (708) 345-8100

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 6

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 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.
518 services192 patients
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.
500 services97 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.
181 services172 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.
127 services122 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.
34 services34 patients
Critical care, first 30-74 minutes 99291
Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.
27 services19 patients

Hospital Affiliations CMS Care Compare 3

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

Edward Hospital

Acute Care Hospitals · Naperville, IL
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140231
Location801 South WashingtonNaperville, IL 60540 · Du Page County
Emergency services Birthing friendly

Uchicago Medicine Adventhealth Glenoaks

Acute Care Hospitals · Glendale Heights, IL
3/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number140292
Location701 Winthrop AvenueGlendale Heights, IL 60139 · Du Page County
Emergency services Birthing friendly

Uchicago Medicine Adventhealth Bolingbrook

Acute Care Hospitals · Bolingbrook, IL
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140304
Location500 Remington BoulevardBolingbrook, IL 60440 · Will County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60521 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
$137.43 typical visit price
range $59.81 – $181.38
Typical copayment $34.35 (range $14.95 – $45.34)
Most-billed visit code 99204
Established Patient
$105.07 typical visit price
range $19.15 – $147.12
Typical copayment $26.26 (range $4.78 – $36.78)
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.

75.25/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Individually scored
Quality83.44
Improvement Activities0
Cost64.53

Referred Medical Equipment & Supplies CMS DME claims 3

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

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431
DME-Oxygen and Supplies · category DC000N
4 suppliers30 claims30 services$23.49 avg. paid by Medicare
Nebulizer, with compressor E0570
DME-Other DME · category DE000N
1 supplier11 claims11 services$6.32 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
4 suppliers30 claims30 services$81.96 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 20

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

DU PAGE PATHOLOGY ASSOCIATES SC
Pathology (Anatomic Pathology & Clinical Pathology)
120 N OAK ST
HINSDALE, IL 60521
Dupage County (630) 856-9000
KEITH KEY LEE DO
Anesthesiology (Pediatric Anesthesiology)
120 N OAK ST
HINSDALE, IL 60521
Dupage County (630) 856-9000
ROLAND E. LONSER M.D.
Pathology (Anatomic Pathology & Clinical Pathology)
120 N OAK ST, HINSDALE HOSPITAL / PATHOLOGY DEP
HINSDALE, IL 60521
Dupage County (630) 856-7850
CARLOS O. MARTINEZ MD
Emergency Medicine
120 N OAK ST
HINSDALE, IL 60521
Dupage County (630) 856-6782
AGNIESZKA U. PIOTROWSKI M.D.
Pathology (Anatomic Pathology & Clinical Pathology)
120 N OAK ST, HINSALE HOSPITAL / PATHOLOGY DEPAR
HINSDALE, IL 60521
Dupage County (630) 856-8750
DAVID BERGQUIST M.D
Anesthesiology
120 N OAK ST
HINSDALE, IL 60521
Dupage County (630) 856-9000
YEHUDA LEOR BROMBERG NP
Nurse Practitioner
120 N OAK ST
HINSDALE, IL 60521
Dupage County (630) 856-6700
ESHPREET KULAR RN
Registered Nurse
120 N OAK ST
HINSDALE, IL 60521
Dupage County (630) 856-9000

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 Roy Settergren's NPI number?

The NPI number for Roy Settergren is 1194055863. It was assigned to this individual provider in the NPPES registry on January 2, 2010.

Where is Roy Settergren located?

Roy Settergren practices at 120 N Oak St, Hinsdale, IL 60521. The listed phone number is (630) 856-9000.

What is Roy Settergren's specialty?

The primary specialty registered for this NPI is Hospitalist with taxonomy code 208M00000X.

Is Roy Settergren enrolled in Medicare?

Yes. Roy Settergren 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 Roy Settergren's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Roy Settergren reassigns Medicare benefits to 2 organizations: Advance Inpatient Medicine LLC (Oak Brook, IL) and Knd Development 59 LLC (Northlake, IL). 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 Roy Settergren's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Roy Settergren accept?

Health plans from Oscar Health list Roy Settergren 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 Roy Settergren affiliated with any hospitals?

According to CMS data, Roy Settergren is affiliated with Edward Hospital, Uchicago Medicine Adventhealth Glenoaks and Uchicago Medicine Adventhealth Bolingbrook.

When was this NPI record last updated?

The NPPES record for Roy Settergren was last updated on October 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months 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.