DR. SUMIT ISHARWAL MD
NPI 1538455191
Urology in Jacksonville, FL

Q: What is Sumit Isharwal's NPI number?

The NPI number for Sumit Isharwal is 1538455191. It was assigned to this individual provider in the NPPES registry on June 22, 2011.

Q: What is Sumit Isharwal's specialty?

The primary specialty registered for this NPI is Urology with taxonomy code 208800000X.

Q: When was this NPI record last updated?

The NPPES record for Sumit Isharwal was last updated on April 30, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months 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 June 22, 2011PECOS EnrolledAccepts Medicare Assignment

79.39/100

CMS Quality Rating

1301 PALM AVE STE 500, JACKSONVILLE, FL 32207(904) 202-7300(904) 202-2754 Get Directions Write a Review

NPPES record last updated: April 30, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Aug 6, 2024, Aug 3, 2018, Nov 14, 2017 (3 updates tracked since 2017).

On this page

About Dr. Sumit Isharwal Md NPPES

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

DR. SUMIT ISHARWAL MD (NPI 1538455191) is an individual urology provider in Jacksonville, Florida, licensed in Florida (ME1644485) and active in the NPI registry since June 2011. He is enrolled in Medicare PECOS, is affiliated with Baptist Health Medical Center - Jacksonville, and is a graduate of Other (2006).

NPPES Registry Identity

NPI1538455191

Entity TypeIndividualMale

Primary Taxonomy208800000X

Provider Legal NameDR. SUMIT ISHARWALCredential: MD

Location Address1301 PALM AVE STE 500Jacksonville, FL 32207-8432

Mailing AddressPo Box 746654Atlanta, GA 30374-6654 · (904) 202-2092 · Fax (904) 376-4075

Phone(904) 202-7300

Fax(904) 202-2754

Sole ProprietorNo

Medical School CMSOtherGraduated 2006

Enumeration DateJune 22, 2011

Last NPPES UpdateApril 30, 20253 updates tracked since enumeration

NPPES CertifiedApril 30, 2025

✔ NPI 1538455191 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyUrologyAllopathic & Osteopathic Physicians

Taxonomy Code208800000X

Licenses✔ Licensed in FL · ME1644485✔ Licensed in NY · 288302✔ Licensed in VA · 0101264513

Definition

A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

1301 PALM AVE STE 500, Jacksonville, FL 32207

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include AvMed, Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).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. Sumit Isharwal 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 ID7416253935

PECOS Enrollment IDI20240815000895

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

Medicare enrollment records show Sumit Isharwal reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Baptist MD Anderson Cancer Physicians Inc

0.1 mi

Hematology & Oncology

1235 SAN MARCO BLVD, SUITE 2
Jacksonville, FL 32207

Reassigned Medicare billing, Florida enrollment
106 clinicians in this Medicare group

NPI 1538593124 (904) 202-7300

University Of Virginia Physicians Group

561 mi

Neuromusculoskeletal Medicine, Sports Medicine

4105 LEWIS AND CLARK DR
Charlottesville, VA 22911

Reassigned Medicare billing, Virginia enrollment
2,820 clinicians in this Medicare group

NPI 1033138250 (434) 295-1000

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 7

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 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.

43 services37 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.

43 services41 patients

Ultrasound scan of pelvic region through rectum 76872

An ultrasound scan of the pelvic region through the rectum is a medical procedure where a small, smooth device is gently inserted into the rectum. This device uses sound waves to create images of the internal structures in the lower abdomen, aiding in diagnosis and treatment planning.

13 services13 patients

Diagnostic exam of bladder and urethra using an endoscope 52000

This procedure involves using a thin, flexible tube with a light, called an endoscope, to examine the bladder and urethra. It helps in identifying any abnormalities or issues that may be causing discomfort or other symptoms.

12 services12 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.

12 services12 patients

Biopsy of prostate gland 55700

A biopsy of the prostate gland is a procedure where a small sample of tissue is taken from your body's internal gland, located near the bladder, for testing. This helps in diagnosing potential health issues. It's usually done with a fine needle and imaging technology for accuracy.

11 services11 patients

Hospital Affiliations CMS Care Compare 3

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

Baptist Health Medical Center - Jacksonville

Acute Care Hospitals · Jacksonville, FL

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number100088

Location800 Prudential DrJacksonville, FL 32207 · Duval County

Emergency services Birthing friendly

Baptist Medical Center Beaches

Acute Care Hospitals · Jacksonville Beach, FL

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number100117

Location1350 13th Ave SJacksonville Beach, FL 32250 · Duval County

Emergency services Birthing friendly

Baptist Medical Center - Nassau

Acute Care Hospitals · Fernandina Beach, FL

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number100140

Location1250 S 18th StFernandina Beach, FL 32034 · Nassau County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32207 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

$70.04 typical visit price

range $17.57 – $139.16

Typical copayment $17.51 (range $4.39 – $34.79)

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.

79.39/100

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

Scored as part of a group practice

Quality

73.66

Promoting Interoperability

100

Improvement Activities

Cost

57.65

Referred Medical Equipment & Supplies CMS DME claims 5

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

Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each A4351

DME-Orthotic Devices · category DF008N

1 supplier28 claims3,574 services$1.55 avg. paid by Medicare

Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each A4357

DME-Orthotic Devices · category DF000N

5 suppliers29 claims57 services$8.15 avg. paid by Medicare

Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each A4432

DME-Orthotic Devices · category DF010N

3 suppliers11 claims500 services$3.33 avg. paid by Medicare

Adhesive remover or solvent (for tape, cement or other adhesive), per ounce A4455

DME-Medical/Surgical Supplies · category DA000N

3 suppliers15 claims72 services$1.33 avg. paid by Medicare

Adhesive remover, wipes, any type, each A4456

DME-Medical/Surgical Supplies · category DA000N

4 suppliers20 claims1,200 services$0.23 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.

MEGHAN KENNEDY HALL PA-C

Physician Assistant