Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

DR. SUSHMA RAI M.D.
NPI 1528072741
Ophthalmology in Phoenix, AZ

Q: What is Sushma Rai's NPI number?

The NPI number for Sushma Rai is 1528072741. It was assigned to this individual provider in the NPPES registry on July 27, 2006.

Q: What is Sushma Rai's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Sushma Rai was last updated on June 25, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 48 days 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 July 27, 2006PECOS EnrolledAccepts Medicare Assignment

93.37/100

CMS Quality Rating

4212 N 16TH ST, PHOENIX, AZ 85016(602) 263-1200(602) 263-1619 Get Directions Write a Review

NPPES record last updated: June 25, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Dr. Sushma Rai M.d. NPPES

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

DR. SUSHMA RAI M.D. (NPI 1528072741) is an individual ophthalmology provider in Phoenix, Arizona, licensed in Arizona (49918) and active in the NPI registry since July 2006. She is enrolled in Medicare PECOS and is a graduate of Other (1985).

NPPES Registry Identity

NPI1528072741

Entity TypeIndividualFemale

Primary Taxonomy207W00000X

Provider Legal NameDR. SUSHMA RAICredential: M.D.

Location Address4212 N 16TH STPhoenix, AZ 85016-5319

Mailing AddressPo Box 95460Cleveland, OH 44101-0033 · (602) 581-6076 · Fax (602) 263-1619

Phone(602) 263-1200

Fax(602) 263-1619

Sole ProprietorNo

Medical School CMSOtherGraduated 1985

Enumeration DateJuly 27, 2006

Last NPPES UpdateJune 25, 2026

NPPES CertifiedJune 25, 2026

✔ NPI 1528072741 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOphthalmologyAllopathic & Osteopathic Physicians

Taxonomy Code207W00000X

License✔ Licensed in AZ · 49918

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.

4212 N 16TH ST, Phoenix, AZ 85016

Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Arizona.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. Sushma Rai 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 ID345241469

PECOS Enrollment IDI20240523003877

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 8

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.

98 services65 patients

Exam of visual field with intermediate testing 92082

An exam of the visual field with intermediate testing is a procedure that checks your peripheral (side) vision. It helps to identify blind spots which could be a sign of eye diseases. This non-invasive test is painless and quick.

52 services45 patients

Exam of the internal drainage system of eye 92020

This is a procedure where your doctor examines the eye's internal drainage system, essential for maintaining eye pressure. They use specialized tools to check for blockages or damage that might lead to conditions like glaucoma. It's non-invasive and painless.

51 services50 patients

Ultrasound scan of cornea to determine thickness 76514

An ultrasound scan of the cornea is a non-invasive procedure that uses sound waves to measure the thickness of your cornea. This helps in diagnosing certain eye conditions and planning treatments. No discomfort or pain is typically experienced.

45 services45 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.

29 services29 patients

Ultrasound scan to determine eye length and lens power 76519

An ultrasound scan for the eye is a safe, non-invasive procedure. It uses sound waves to create images of your eye's structure. This helps determine the length of your eye and the power of your lens, which is crucial for diagnosing eye conditions and planning surgeries.

21 services20 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85016 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

$127.71 typical visit price

range $55.44 – $168.60

Typical copayment $31.92 (range $13.86 – $42.15)

Most-billed visit code 99204

Established Patient

$69.24 typical visit price

range $17.72 – $137.41

Typical copayment $17.31 (range $4.43 – $34.35)

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.

93.37/100

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

Scored as part of a group practice

Quality

94.57

Promoting Interoperability

Improvement Activities

Cost

62.14

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.

WENDY RAZO

Registered Nurse (Obstetric, High-Risk)