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SUMIT SITOLE M.D.
NPI 1205088507
Ophthalmology in Denver, CO

Active since October 17, 2008PECOS EnrolledAccepts Medicare Assignment
82.22/100
CMS Quality Rating
55 MADISON ST, 355, DENVER, CO 80206(303) 377-2020(303) 388-0606 Get Directions Write a Review

NPPES record last updated: September 10, 2012. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Sumit Sitole M.d. NPPES

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

SUMIT SITOLE M.D. (NPI 1205088507) is an individual ophthalmology provider in Denver, Colorado, licensed in Maryland (D67988) and active in the NPI registry since October 2008. He is enrolled in Medicare PECOS and is a graduate of Tufts University School Of Medicine (2004).

NPPES Registry Identity

NPI1205088507
Entity TypeIndividualMale
Primary Taxonomy207W00000X
Provider Legal NameSUMIT SITOLECredential: M.D.
Location Address55 MADISON ST, 355Denver, CO 80206-5419
Mailing Address5245 Skytrail DrBow Mar, CO 80123-1566 · (617) 320-0321
Phone(303) 377-2020
Fax(303) 388-0606
Sole ProprietorNo
Medical School CMSTufts University School Of MedicineGraduated 2004
Enumeration DateOctober 17, 2008
Last NPPES UpdateSeptember 10, 2012
✔ NPI 1205088507 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOphthalmologyAllopathic & Osteopathic Physicians
Taxonomy Code207W00000X
License✔ Licensed in MD · D67988
Definition
An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.
55 MADISON ST, Denver, CO 80206
Open in Google Maps ↗

Other Identifiers 3

Medicaid84034785CO
Other49102CO · Medical License
Medicare PINS572MD

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include UnitedHealthcare.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

Sumit Sitole 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 ID840352159
PECOS Enrollment IDI20101013000506
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 9

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.

Photography of content of eyes 92285
Photography of the content of eyes, also known as ocular photography, captures detailed images of different parts of the eye. It helps identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. The process is non-invasive and painless.
154 services147 patients
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203
This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
147 services147 patients
Exam of visual field with extended testing 92083
An extended visual field exam is a detailed test to evaluate your peripheral (side) vision. It helps to detect any potential blind spots which may not be noticeable in daily life. These could be caused by eye diseases like glaucoma, or neurological conditions.
97 services94 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.
65 services54 patients
Extensive repair of turning-outward eyelid defect 67917
This procedure corrects an eyelid defect where the eyelid turns outward, exposing the eye. The extensive repair involves surgical techniques to reshape the eyelid and ensure it functions properly. This helps protect the eye and improve comfort.
40 services36 patients
Extensive repair of turning-outward eyelid defect 67917
This procedure corrects an eyelid defect where the eyelid turns outward, exposing the eye. The extensive repair involves surgical techniques to reshape the eyelid and ensure it functions properly. This helps protect the eye and improve comfort.
24 services22 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 80206 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
$132.55 typical visit price
range $58.06 – $174.82
Typical copayment $33.13 (range $14.51 – $43.70)
Most-billed visit code 99204
Established Patient
$72.20 typical visit price
range $18.88 – $142.79
Typical copayment $18.05 (range $4.72 – $35.69)
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.

82.22/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Individually scored
Quality64.45
Improvement Activities40

Reported Quality Measures

Breast Cancer Screening
0%280 patients1/55-star benchmark: 93%
Diabetes: Eye Exam
0%27 patients1/55-star benchmark: 100%
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
Lower rates are better for this measure.
100%27 patients1/55-star benchmark: 91%
Documentation of Current Medications in the Medical Record
97%953 patients4/55-star benchmark: 100%
Falls: Screening for Future Fall Risk
0%451 patients1/55-star benchmark: 100%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
31%798 patients2/55-star benchmark: 98%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Patients screened: 0% · 489 patients
0%489 patients
Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
77%181 patients4/55-star benchmark: 91%
Use of High-Risk Medications in Older Adults
Lower rates are better for this measure.
Patients appropriateDiagnosis: 0% · 475 patients
Patients totalRate: 0% · 475 patients
0%475 patients5/55-star benchmark: 100%
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.

Other Providers at the Same Location NPPES 17

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

DR. CYNTHIA MARIE PARKINSON DDS
Dentist
55 MADISON ST, STE 320
DENVER, CO 80206
Denver County (303) 355-3080
KRISTINE FROEHLICH LCSW
Social Worker (Clinical)
55 MADISON ST
DENVER, CO 80206
Denver County (262) 853-4942
MADISON STREET ANESTHESIA LLC
Nurse Anesthetist, Certified Registered
55 MADISON ST, 355
DENVER, CO 80206
Denver County (303) 377-2020
DR. JASON WANG MD
Ophthalmology
55 MADISON ST, 355
DENVER, CO 80206
Denver County (303) 398-7320
DR. HOWARD AMIEL M.D., M.S.
Ophthalmology
55 MADISON ST, 355
DENVER, CO 80206
Denver County (303) 398-7309
MADISON STREET SURGERY CENTER, LLC
Clinic/Center (Ambulatory Surgical)
55 MADISON ST, 200
DENVER, CO 80206
Denver County (303) 388-0599
MADISON STREET COMPANY NURSE PRACTITIONER LLC
Nurse Practitioner
55 MADISON ST, STE 355
DENVER, CO 80206
Denver County (303) 377-2020
MR. WILLIAM MERRITT ECKERT CRNA
Nurse Anesthetist, Certified Registered
55 MADISON ST, STE 200
DENVER, CO 80206
Denver County (303) 388-0599

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 Sumit Sitole's NPI number?

The NPI number for Sumit Sitole is 1205088507. It was assigned to this individual provider in the NPPES registry on October 17, 2008.

Where is Sumit Sitole located?

Sumit Sitole practices at 55 Madison St 355, Denver, CO 80206. The listed phone number is (303) 377-2020.

What is Sumit Sitole's specialty?

The primary specialty registered for this NPI is Ophthalmology with taxonomy code 207W00000X.

Is Sumit Sitole enrolled in Medicare?

Yes. Sumit Sitole 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 Sumit Sitole accept?

Health plans from UnitedHealthcare list Sumit Sitole 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 Sumit Sitole was last updated on September 10, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.