DR. SUMIT KUMAR M.D. NPI 1598743098

Internal Medicine (Nephrology) in Dallas, TX

NPI 1598743098 Individual Male Years of Experience 31 Internal Medicine Nephrology PECOS Enrolled Accepts Medicare Approved Payment Medicare Quality Reporting


Sumit Kumar is an internal medicine provider established in Dallas, Texas and his medical specialization is internal medicine (nephrology) with more than 31 years of experience. The NPI number of Sumit Kumar is 1598743098 and was assigned on January 2006. The practitioner's primary taxonomy code is 207RN0300X with license number L2973 (TX). The provider is registered as an individual and his NPI record was last updated 8 years ago.

An internist like Dr. Sumit Kumar M.d. is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.

Sumit Kumar is enrolled in PECOS and is eligible to order or refer healthcare services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices

Sumit Kumar is registered with Medicare and accepts claims assignment, this means the provider accepts Medicare's approved amount for the cost of rendered services as full payment. Participating providers may not charge Medicare beneficiaries more than Medicare's approved amount for their services. Medicare beneficiaries still have to pay a coinsurance or copayment amount for a visit or service. According to Medicare claims data he has hospital affiliations with Texas Health Presbyterian Hospital Dallas, Medical City Dallas Hospital, Medical City Plano and Texas Health Presbyterian Hospital Kaufman.

The provider participated in Medicare's Quality Payment Program and the following quality measures were reported: care plan, diabetes: medical attention for nephropathy, documentation of current medications in the medical record, engage patients and families to guide improvement in the system of care, engagement of patients, family, and caregivers in developing a plan of care, e-prescribing, health information exchange, implementation of improvements that contribute to more timely communication of test results, implementation of medication management practice improvements, medication reconciliation, onc direct review attestation, patient-specific education, pi bonus for submission of eligible improvement activities using cehrt, preventive care and screening: body mass index (bmi) screening and follow-up plan, preventive care and screening: unhealthy alcohol use: screening & brief counseling, provide patient access, secure messaging and security risk analysis. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries.



Provider NameDR. SUMIT KUMAR M.D.
Provider Location Address9900 N CENTRAL EXPY STE 215 DALLAS, TX 75231
Provider Mailing Address9900 N CENTRAL EXPY STE 215 DALLAS, TX 75231
NPI Entity TypeIndividual
Medical School NameOTHER
Graduation Year1991
Is Sole Proprietor?Yes
Is Organization Subpart?N/A
Enumeration Date01-04-2006
Last Update Date09-30-2013

Primary Taxonomy

Taxonomy Code207RN0300X
ClassificationInternal Medicine
TypeAllopathic & Osteopathic Physicians
License No.L2973
License StateTX
Taxonomy DescriptionAn internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.

Business Address

ZIP 75231
Phone: (214) 396-4950
Fax: (877) 423-5360

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Mailing Address

ZIP 75231
Phone: (214) 396-4950
Fax: (877) 423-5360

Medicare Participation

Registered in PECOS? Yes What is PECOS?
PECOS is the Medicare Provider, Enrollment, Chain and Ownership System. PECOS is Medicare's enrollment and revalidation system and it is the primary source of information about verified Medicare professionals. A NPI number is necessary to register in PECOS. Providers must enroll in PECOS to avoid denied claims.
PECOS PAC ID3678679776
PECOS Enrollment IDI20091006000705
Accepts Medicare Assignment? Yes "What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.
Eligible order / refer Part B Clinical Laboratory and ImagingYes
Eligible order / refer Durable Medical EquipmentYes
Eligible order / refer Home Health Agency (HHA)Yes
Eligible order / refer Power Mobility DevicesYes

Clinician Utilization

The following Healthcare Common Procedure Coding System (HCPCS) codes were publicly reported as the top services rendered by this provider under the Medicare program for the year 2017. The reported codes are based on the top 5 codes for each available Medicare specialty, excluding evaluation and management codes.

  • 422Hemodialysis procedure with one physician evaluation (HCPCS:90935)
  • 153Dialysis services (4 or more physician visits per month), patient 20 years of age and older (HCPCS:90960)
  • 91Dialysis services (2-3 physician visits per month), patient 20 years of age and older (HCPCS:90961)
  • 25Dialysis services (1 physician visit per month), patient 20 years of age and older (HCPCS:90962)

Quality Reporting

The following quality measures meets Medicare's statistical reporting standards for the year 2018. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

Quality Measure Performance Rate Number of Patients
Care Plan 100% 434
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan
Diabetes: Medical Attention for Nephropathy 100% 266
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
Documentation of Current Medications in the Medical Record 100% 1638
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration
e-Prescribing 86% 638
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Health Information Exchange 19% 42
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for at least one transition of care or referral.
Medication Reconciliation 100% 21
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
Patient-Specific Education 66% 316
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 99% 719
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2
Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling 100% 470
Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 24 months AND who received brief counseling if identified as an unhealthy alcohol user
Provide Patient Access 85% 316
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information.
Secure Messaging 77% 316
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period.

Hospital Affiliations

Medicare hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the Medicare claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Sumit Kumar is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
DALLAS, TX 75231
(214) 345-6789Acute Care Hospitals450462
DALLAS, TX 75230
(972) 566-6222Acute Care Hospitals450647
PLANO, TX 75075
(972) 596-6800Acute Care Hospitals450651
(972) 932-7200Acute Care Hospitals450292

Additional Identifiers

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
149501201MEDICAID (05)TX
390008049MEDICARE PIN (08)TX

Other Providers at the same location

The following 5 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1538327150 SHAUN P KAISER MD
Internal Medicine (Nephrology)9900 N CENTRAL EXPY STE 215
DALLAS, TX 75231
(214) 396-4950
Internal Medicine (Nephrology)9900 N CENTRAL EXPY STE 215
DALLAS, TX 75231
(214) 396-4950
Nurse Practitioner9900 N CENTRAL EXPY STE 215
DALLAS, TX 75231
(214) 396-4950
Internal Medicine (Nephrology)9900 N CENTRAL EXPY STE 215
DALLAS, TX 75231
(214) 396-4950
1225297922DR. VIVEK SHARMA M.D.
Internal Medicine (Nephrology)9900 N CENTRAL EXPY STE 215
DALLAS, TX 75231
(214) 396-4950

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.