DR. JOSE M NIETO DO
NPI 1225190002
Internal Medicine - Gastroenterology in Sebring, FL

Q: What is Jose Nieto's NPI number?

The NPI number for Jose Nieto is 1225190002. It was assigned to this individual provider in the NPPES registry on December 15, 2006.

Q: What is Jose Nieto's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Gastroenterology, with taxonomy code 207RG0100X.

Q: When was this NPI record last updated?

The NPPES record for Jose Nieto was last updated on February 8, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.

Active since December 15, 2006PECOS EnrolledAccepts Medicare Assignment

90.48/100

CMS Quality Rating

4200 SUN N LAKE BLVD, SEBRING, FL 33872(863) 402-3103 Get Directions Write a Review

NPPES record last updated: February 8, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Dr. Jose M Nieto Do NPPES

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

DR. JOSE M NIETO DO (NPI 1225190002) is an individual gastroenterology provider in Sebring, Florida, licensed in Florida (OS10072) and active in the NPI registry since December 2006. He is enrolled in Medicare PECOS, maintains a secondary practice location in Jacksonville, and is a graduate of Other (2000).

NPPES Registry Identity

NPI1225190002

Entity TypeIndividualMale

Primary Taxonomy207RG0100X

Provider Legal NameDR. JOSE M NIETOCredential: DO

Location Address4200 SUN N LAKE BLVDSebring, FL 33872-1986

Mailing Address4200 Sun N Lake BlvdSebring, FL 33872-1986 · (863) 402-3103

Phone(863) 402-3103

Sole ProprietorNo

Medical School CMSOtherGraduated 2000

Enumeration DateDecember 15, 2006

Last NPPES UpdateFebruary 8, 2023

NPPES CertifiedFebruary 8, 2023

✔ NPI 1225190002 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · GastroenterologyAllopathic & Osteopathic Physicians

Taxonomy Code207RG0100X

Licenses✔ Licensed in FL · OS10072✔ Licensed in CA · 20A8097

Definition

An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.

4200 SUN N LAKE BLVD, Sebring, FL 33872

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Secondary Practice Location 1

Location 14800 Belfort RdJacksonville, FL 32256-6004 · Phone (904) 398-7205 · Fax (904) 396-4047

Other Identifiers 2

Medicaid279200100FL

Other16365FL · Bcbs Fl

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.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. Jose M Nieto Do 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 ID2365498664

PECOS Enrollment IDI20070924000168

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 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.

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

47 services47 patients

Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239

This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.

31 services31 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.

29 services18 patients

Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43242

This procedure involves using an ultrasound to guide a needle to specific areas in the esophagus, stomach, or upper small bowel. A flexible endoscope is used to reach these areas. The needle collects a small sample for testing.

24 services24 patients

Ultrasound exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43259

This procedure involves a flexible tube with a camera, called an endoscope, inserted through your mouth to examine your esophagus, stomach, and upper small bowel. An ultrasound device on the endoscope helps get detailed images. It's safe and helps diagnose various conditions.

15 services15 patients

Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99231

Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.

15 services11 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 33872 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

$130.04 typical visit price

range $56.00 – $171.84

Typical copayment $32.51 (range $14.00 – $42.96)

Most-billed visit code 99204

Established Patient

$99.16 typical visit price

range $17.57 – $139.16

Typical copayment $24.79 (range $4.39 – $34.79)

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.

90.48/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored through an Alternative Payment Model

Quality

74.5

Promoting Interoperability

95.74

Improvement Activities

Reported Quality Measures

Colorectal Cancer Screening

Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer

83%199 patients4/55-star benchmark: 85%

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.

92%559 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.

93%844 patients4/55-star benchmark: 100%

Medication Reconciliation

The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.

91%187 patients4/55-star benchmark: 100%

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.

46%424 patients2/55-star benchmark: 100%

Pneumococcal Vaccination Status for Older Adults

Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine

18%142 patients1/55-star benchmark: 90%

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…

10%358 patients1/55-star benchmark: 97%

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user

Patients screenedForUse: 68% · 206 patients

Patients tobacco: 4% · 27 patients

58%206 patients3/55-star benchmark: 98%

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…

93%424 patients4/55-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…

43%424 patients3/55-star benchmark: 79%

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 20

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

RAJKARAN BANGA MD

Student in an Organized Health Care Education/Training Program