DR. SUSHIL ADHIKARI M.D.
NPI 1295907301
Hospitalist in San Jose, CA

Q: What is Sushil Adhikari's NPI number?

The NPI number for Sushil Adhikari is 1295907301. It was assigned to this individual provider in the NPPES registry on March 28, 2008.

Q: What is Sushil Adhikari's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Sushil Adhikari was last updated on December 27, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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 March 28, 2008PECOS EnrolledAccepts Medicare Assignment

80.58/100

CMS Quality Rating

2105 FOREST AVE, SAN JOSE, CA 95128(408) 947-2500 Get Directions Write a Review

NPPES record last updated: December 27, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 27, 2021, Jul 1, 2021 (2 updates tracked since 2021).

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About Dr. Sushil Adhikari M.d. NPPES

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

DR. SUSHIL ADHIKARI M.D. (NPI 1295907301) is an individual hospitalist provider in San Jose, California, licensed in California (C171400) and active in the NPI registry since March 2008. He is enrolled in Medicare PECOS, maintains a secondary practice location in Gilroy, and is a graduate of Other (2003).

NPPES Registry Identity

NPI1295907301

Entity TypeIndividualMale

Primary Taxonomy208M00000X

Provider Legal NameDR. SUSHIL ADHIKARICredential: M.D.

Location Address2105 FOREST AVESan Jose, CA 95128-1425

Mailing Address6480 Godani StGilroy, CA 95020-2719 · (773) 629-2176

Phone(408) 947-2500

Sole ProprietorNo

Medical School CMSOtherGraduated 2003

Enumeration DateMarch 28, 2008

Last NPPES UpdateDecember 27, 20212 updates tracked since enumeration

NPPES CertifiedJuly 1, 2021

✔ NPI 1295907301 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyHospitalistAllopathic & Osteopathic Physicians

Taxonomy Code208M00000X

License✔ Licensed in CA · C171400

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.

Also ListedInternal MedicineTaxonomy 207R00000X · License 52732 (MN), 125053284 (IL), 036124008 (IL)

2105 FOREST AVE, San Jose, CA 95128

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Secondary Practice Location 1

Location 19400 N Name UnoGilroy, CA 95020-3528 · Phone (408) 848-2000

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. Sushil Adhikari 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 ID8426172404

PECOS Enrollment IDI20210610002882

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.

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.

404 services169 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.

153 services143 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.

58 services56 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.

46 services45 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.

37 services19 patients

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.

35 services29 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95128 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

$156.67 typical visit price

range $70.37 – $206.04

Typical copayment $39.16 (range $17.59 – $51.51)

Most-billed visit code 99204

Established Patient

$121.77 typical visit price

range $23.96 – $169.60

Typical copayment $30.44 (range $5.99 – $42.40)

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.

80.58/100

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

Scored as part of a group practice

Quality

67.43

Promoting Interoperability

100

Improvement Activities

Cost

46.5

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.

Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) E0465

DME-Other DME · category DE005N

1 supplier12 claims22 services$919.83 avg. paid by Medicare

Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) E0630

DME-Other DME · category DE000N

2 suppliers11 claims11 services$34.92 avg. paid by Medicare

Standard wheelchair K0001

DME-Wheelchairs · category DD000N

2 suppliers17 claims17 services$9.24 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.

ANNA NGUYEN DO

Emergency Medicine