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DR. GRAYSON SUGARMAN M.D.
NPI 1366744831
Internal Medicine in Cincinnati, OH

Active since December 03, 2010PECOS EnrolledAccepts Medicare Assignment
85.49/100
CMS Quality Rating
3805 EDWARDS RD, SUITE 350, CINCINNATI, OH 45209(513) 321-0833(513) 321-6063 Get Directions Write a Review

NPPES record last updated: October 28, 2020. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Oct 28, 2020, Nov 18, 2016 (2 updates tracked since 2016).

About Dr. Grayson Sugarman M.d. NPPES

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

DR. GRAYSON SUGARMAN M.D. (NPI 1366744831) is an individual internal medicine provider in Cincinnati, Ohio, licensed in Ohio (35.121366) and active in the NPI registry since December 2010. He is enrolled in Medicare PECOS, is affiliated with St Elizabeth Ft Thomas, and is a graduate of University Of Kentucky College Of Medicine (2010).

NPPES Registry Identity

NPI1366744831
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameDR. GRAYSON SUGARMANCredential: M.D.
Location Address3805 EDWARDS RD, SUITE 350Cincinnati, OH 45209-1900
Mailing Address3805 Edwards Rd, Suite 350Cincinnati, OH 45209-1900 · (513) 321-0833 · Fax (513) 321-6063
Phone(513) 321-0833
Fax(513) 321-6063
Sole ProprietorNo
Medical School CMSUniversity Of Kentucky College Of MedicineGraduated 2010
Enumeration DateDecember 3, 2010
Last NPPES UpdateOctober 28, 20202 updates tracked since enumeration
NPPES CertifiedOctober 28, 2020
✔ NPI 1366744831 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in OH · 35.121366
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
3805 EDWARDS RD, Cincinnati, OH 45209
Open in Google Maps ↗

Other Identifiers 1

Medicaid0089344OH

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, CareSource, Molina Healthcare and more.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. Grayson Sugarman 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 ID1759523624
PECOS Enrollment IDI20130806000873
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 Grayson Sugarman reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Sugarman & Rozzo Internal Medicine LLC
2.0 mi
Internal Medicine
5400 KENNEDY AVE STE 4
Cincinnati, OH 45213
  • Reassigned Medicare billing, Ohio enrollment
  • 2 clinicians in this Medicare group
NPI 1992684336 (513) 458-3685
John J. Zerbe, M.D. General Internal Medicine Inc
2.0 mi
Specialist
5400 KENNEDY AVE
Cincinnati, OH 45213
  • Reassigned Medicare billing, Ohio enrollment
  • 3 clinicians in this Medicare group
NPI 1972774305 (513) 458-3685

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 5

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.
82 services57 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.
47 services30 patients
Annual depression screening, 5 to 15 minutes G0444
An annual depression screening is a short, routine evaluation to check for signs of depression. It involves answering a series of questions about your feelings, thoughts, and behaviors. The process takes about 15 minutes and helps detect depression early for better management.
40 services40 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.
38 services38 patients
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.
22 services22 patients

Hospital Affiliations CMS Care Compare 5

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

St Elizabeth Ft Thomas

Acute Care Hospitals · Fort Thomas, KY
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number180001
Location85 North Grand AvenueFort Thomas, KY 41075 · Campbell County
Emergency services

Mercy Health-Anderson Hospital

Acute Care Hospitals · Cincinnati, OH
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number360001
Location7500 State RoadCincinnati, OH 45255 · Hamilton County
Emergency services Birthing friendly

Christ Hospital

Acute Care Hospitals · Cincinnati, OH
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number360163
Location2139 Auburn AvenueCincinnati, OH 45219 · Hamilton County
Emergency services Birthing friendly

Bethesda North

Acute Care Hospitals · Cincinnati, OH
3/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number360179
Location10500 Montgomery RoadCincinnati, OH 45242 · Hamilton County
Emergency services Birthing friendly

Mercy Health - Clermont Hospital

Acute Care Hospitals · Batavia, OH
4/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number360236
Location3000 Hospital DriveBatavia, OH 45103 · Clermont County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 45209 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
$126.12 typical visit price
range $54.34 – $166.65
Typical copayment $31.53 (range $13.58 – $41.66)
Most-billed visit code 99204
Established Patient
$96.44 typical visit price
range $17.10 – $135.40
Typical copayment $24.11 (range $4.27 – $33.85)
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.

85.49/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality91.06
Promoting Interoperability100
Improvement Activities40
Cost60.59

Referred Medical Equipment & Supplies CMS DME claims 2

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
6 suppliers14 claims34 services$5.06 avg. paid by Medicare
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
2 suppliers12 claims12 services$179.69 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 17

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

KELLY JEWELL RD, LD
Dietitian, Registered
3805 EDWARDS RD, SUITE 400
CINCINNATI, OH 45209
Hamilton County (513) 808-9220
DAVID CARL FISHER M.D.
Internal Medicine
3805 EDWARDS RD, SUITE 350
CINCINNATI, OH 45209
Hamilton County (513) 321-0833
ALLIANCE PRIMARY CARE
Internal Medicine
3805 EDWARDS RD, STE. 300
CINCINNATI, OH 45209
Hamilton County (513) 585-9700
DR. JON E MENDELSOHN MD FACS
Plastic Surgery (Plastic Surgery Within the Head and Neck)
3805 EDWARDS RD, SUITE 100
CINCINNATI, OH 45209
Hamilton County (513) 351-3223
ADVANCED COSMETIC SURGERY & LASER CENTER OF HYDE PARK, INC.
Clinic/Center (Ambulatory Surgical)
3805 EDWARDS RD, SUITE 100
CINCINNATI, OH 45209
Hamilton County (513) 351-3223
DANIEL ANTHONY SILVESTRI M.D.
Internal Medicine
3805 EDWARDS RD, SUITE 300
CINCINNATI, OH 45209
Hamilton County (513) 871-5900
EATING RECOVERY CENTER OF OHIO, LLC
Clinic/Center (Mental Health (Including Community Mental Health Center))
3805 EDWARDS RD, SUITE 400
CINCINNATI, OH 45209
Hamilton County (312) 540-9955
DOUGLAS C BRENGLE MD
Internal Medicine
3805 EDWARDS RD, STE. 300
CINCINNATI, OH 45209
Hamilton County (513) 585-9700

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 Grayson Sugarman's NPI number?

The NPI number for Grayson Sugarman is 1366744831. It was assigned to this individual provider in the NPPES registry on December 3, 2010.

Where is Grayson Sugarman located?

Grayson Sugarman practices at 3805 Edwards Rd Suite 350, Cincinnati, OH 45209. The listed phone number is (513) 321-0833.

What is Grayson Sugarman's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Grayson Sugarman enrolled in Medicare?

Yes. Grayson Sugarman 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 Grayson Sugarman's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Grayson Sugarman reassigns Medicare benefits to 2 organizations: Sugarman & Rozzo Internal Medicine LLC (Cincinnati, OH) and John J. Zerbe, M.D. General Internal Medicine Inc (Cincinnati, OH). 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 Grayson Sugarman's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Grayson Sugarman accept?

Health plans from Anthem Blue Cross and Blue Shield, CareSource, Molina Healthcare and UnitedHealthcare list Grayson Sugarman 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 Grayson Sugarman affiliated with any hospitals?

According to CMS data, Grayson Sugarman is affiliated with St Elizabeth Ft Thomas, Mercy Health-Anderson Hospital, Christ Hospital, Bethesda North and Mercy Health - Clermont Hospital.

When was this NPI record last updated?

The NPPES record for Grayson Sugarman was last updated on October 28, 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.