DR. CRAIG R SUSSMAN MD
NPI 1417049834
Internal Medicine in Nashville, TN

Q: What is Craig Sussman's NPI number?

The NPI number for Craig Sussman is 1417049834. It was assigned to this individual provider in the NPPES registry on September 30, 2006.

Q: What is Craig Sussman's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Craig Sussman was last updated on March 29, 2022. 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 September 30, 2006PECOS EnrolledAccepts Medicare Assignment

97.12/100

CMS Quality Rating

3601 THE VANDERBILT CLINIC, NASHVILLE, TN 37232(615) 936-2000 Get Directions Write a Review

NPPES record last updated: March 29, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

On this page

About Dr. Craig R Sussman Md NPPES

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

DR. CRAIG R SUSSMAN MD (NPI 1417049834) is an individual internal medicine provider in Nashville, Tennessee, licensed in Tennessee (MD10694) and active in the NPI registry since September 2006. He is enrolled in Medicare PECOS, is affiliated with Vanderbilt University Medical Center, and is a graduate of Temple University School Of Medicine (1973).

NPPES Registry Identity

NPI1417049834

Entity TypeIndividualMale

Primary Taxonomy207R00000X

Provider Legal NameDR. CRAIG R SUSSMANCredential: MD

Location Address3601 THE VANDERBILT CLINICNashville, TN 37232-2350

Mailing Address3841 Green Hills Village Dr Ste 200Nashville, TN 37215-2691 · (615) 936-2000

Phone(615) 936-2000

Sole ProprietorNo

Medical School CMSTemple University School Of MedicineGraduated 1973

Enumeration DateSeptember 30, 2006

Last NPPES UpdateMarch 29, 2022

NPPES CertifiedMarch 29, 2022

✔ NPI 1417049834 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

License✔ Licensed in TN · MD10694

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.

Also ListedInternal Medicine · Endocrinology, Diabetes & MetabolismTaxonomy 207RE0101X · License MD10694 (TN)

3601 THE VANDERBILT CLINIC, Nashville, TN 37232

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Other Identifiers 1

Medicaid3169531TN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., BlueCross BlueShield of Tennessee, Oscar Insurance Company.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. Craig R Sussman Md 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 ID244266609

PECOS Enrollment IDI20050718000128

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 4

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.

61 services59 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

22 services21 patients

Continuous monitoring of blood sugar level in tissue fluid using sensor under skin with interpretation and report 95251

This procedure involves placing a small sensor under your skin to continuously monitor your blood sugar levels in tissue fluid. The data is interpreted and a report is generated to help manage your diabetes more effectively.

15 services15 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.

13 services13 patients

Hospital Affiliations CMS Care Compare

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

Vanderbilt University Medical Center

Acute Care Hospitals · Nashville, TN

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number440039

Location1211 Medical Center DriveNashville, TN 37232 · Davidson County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 37232 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

$121.80 typical visit price

range $52.64 – $160.89

Typical copayment $30.45 (range $13.16 – $40.22)

Most-billed visit code 99204

Established Patient

$93.60 typical visit price

range $16.72 – $131.41

Typical copayment $23.40 (range $4.18 – $32.85)

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.

97.12/100

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

Scored through an Alternative Payment Model

Quality

85.64

Promoting Interoperability

100

Improvement Activities

Referred Medical Equipment & Supplies CMS DME claims 6

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

Supplies for maintenance of insulin infusion catheter, per week A4224

DME-Other DME · category DE017N

3 suppliers17 claims217 services$18.78 avg. paid by Medicare

Supplies for external insulin infusion pump, syringe type cartridge, sterile, each A4225

DME-Other DME · category DE017N

3 suppliers17 claims510 services$2.39 avg. paid by Medicare

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253

DME-Other DME · category DE017N

28 suppliers97 claims319 services$6.11 avg. paid by Medicare

Lancets, per box of 100 A4259

DME-Medical/Surgical Supplies · category DA000N

21 suppliers62 claims92 services$1.00 avg. paid by Medicare

Insulin for administration through dme (i.e., insulin pump) per 50 units J1817

Treatment-Injections and Infusions (nononcologic) · category RI000N

4 suppliers27 claims2,320 services$6.99 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

9 suppliers348 claims351 services$186.66 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.

DR. ENGLISH FLACK MD

Pediatrics (Pediatric Cardiology)