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MICHAEL P SUMIDA M.D.
NPI 1609835115
Surgery in Athens, TN

Active since March 22, 2006PECOS EnrolledAccepts Medicare Assignment
719 COOK DR, STE 109, ATHENS, TN 37303(423) 745-2344(423) 745-2314 Get Directions Write a Review

NPPES record last updated: March 1, 2010. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Michael P Sumida M.d. NPPES

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

MICHAEL P SUMIDA M.D. (NPI 1609835115) is an individual surgery provider in Athens, Tennessee, licensed in Tennessee (MD27304) and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS, is affiliated with Starr Regional Medical Center Athens, and is a graduate of University Of Kentucky College Of Medicine (1994).

NPPES Registry Identity

NPI1609835115
Entity TypeIndividualMale
Primary Taxonomy208600000X
Provider Legal NameMICHAEL P SUMIDACredential: M.D.
Location Address719 COOK DR, STE 109Athens, TN 37303-3495
Mailing AddressPo Box 667Etowah, TN 37331-0667 · (423) 745-2344 · Fax (423) 745-2314
Phone(423) 745-2344
Fax(423) 745-2314
Sole ProprietorYes
Medical School CMSUniversity Of Kentucky College Of MedicineGraduated 1994
Enumeration DateMarch 22, 2006
Last NPPES UpdateMarch 1, 2010
✔ NPI 1609835115 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208600000X
License✔ Licensed in TN · MD27304
Definition
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
719 COOK DR, Athens, TN 37303
Open in Google Maps ↗

Other Identifiers 4

Medicare ID-Type Unspecified3096585TN · Medicare
Other3146634TN · Blue Cross Blue Shield
Medicaid3096585TN
Medicare UPING18081TN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Magnolia Health and more.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

Michael P Sumida 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 ID8527183516
PECOS Enrollment IDI20100914001079
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.

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.
120 services120 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.
91 services80 patients
Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239
This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.
41 services41 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.
36 services34 patients
Diagnostic exam of large bowel using a flexible endoscope 45378
This procedure, known as a colonoscopy, involves using a flexible tube with a light and camera to examine the large intestine. It helps detect any abnormalities such as polyps or inflammation. It's a standard procedure to ensure gut health.
28 services28 patients
Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery 45384
This procedure involves using a flexible tube with a camera, called an endoscope, to view the large intestine. If any abnormal growths or polyps are found, they are removed with an electrically-heated instrument. This is a common way to prevent bowel issues.
24 services24 patients

Hospital Affiliations CMS Care Compare

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

Starr Regional Medical Center Athens

Acute Care Hospitals · Athens, TN
4/5 CMS rating
OwnershipProprietary
CMS Certification Number440068
Location1114 W Madison AveAthens, TN 37371 · Mc Minn County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 37303 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
$81.53 typical visit price
range $52.64 – $160.89
Typical copayment $20.38 (range $13.16 – $40.22)
Most-billed visit code 99203
Established Patient
$66.01 typical visit price
range $16.72 – $131.41
Typical copayment $16.50 (range $4.18 – $32.85)
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.

Referred Medical Equipment & Supplies CMS DME claims 3

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

Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each A4409
DME-Orthotic Devices · category DF010N
1 supplier11 claims205 services$5.85 avg. paid by Medicare
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each A4411
DME-Orthotic Devices · category DF010N
1 supplier11 claims220 services$4.52 avg. paid by Medicare
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each A4425
DME-Orthotic Devices · category DF010N
1 supplier11 claims220 services$3.14 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 7

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

DR. WILLIAM R BOWERS MD
Family Medicine
719 COOK DR, SUITE 102
ATHENS, TN 37303
McMinn County (423) 745-1277
MARTHA JEAN PASCARELLA NP
Nurse Practitioner (Family)
719 COOK DR, SUITE 102
ATHENS, TN 37303
McMinn County (423) 745-1277
NICHOLAS BALLAY MD
Surgery
719 COOK DR
ATHENS, TN 37303
McMinn County (423) 745-2344
PRESTON W BROWN M.D.
Surgery
719 COOK DR, STE 109
ATHENS, TN 37303
McMinn County (423) 745-2344
THOMAS S LAYMAN M.D.
Surgery
719 COOK DR, SUITE 110
ATHENS, TN 37303
McMinn County (423) 745-2344
ATHENS PHYSICIANS PRACTICE, LLC
Orthopaedic Surgery
719 COOK DR, SUITE 104
ATHENS, TN 37303
McMinn County (423) 746-2941
CHATTANOOGA ORTHOPAEDIC GROUP, PC
Orthopaedic Surgery
719 COOK DR
ATHENS, TN 37303
McMinn County (423) 624-2696

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 Michael Sumida's NPI number?

The NPI number for Michael Sumida is 1609835115. It was assigned to this individual provider in the NPPES registry on March 22, 2006.

Where is Michael Sumida located?

Michael Sumida practices at 719 Cook Dr Ste 109, Athens, TN 37303. The listed phone number is (423) 745-2344.

What is Michael Sumida's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Is Michael Sumida enrolled in Medicare?

Yes. Michael Sumida 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.

What insurance does Michael Sumida accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Magnolia Health, Ambetter of Alabama and Ambetter of North Carolina and 3 other insurers list Michael Sumida 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 Michael Sumida affiliated with any hospitals?

According to CMS data, Michael Sumida is affiliated with Starr Regional Medical Center Athens.

When was this NPI record last updated?

The NPPES record for Michael Sumida was last updated on March 1, 2010. NPI Profile syncs with the weekly NPPES data releases published by CMS.