SETU PATOLIA
NPI 1649418104
Internal Medicine - Pulmonary Disease in Saint Louis, MO

Q: What is Setu Patolia's NPI number?

The NPI number for Setu Patolia is 1649418104. It was assigned to this individual provider in the NPPES registry on January 21, 2009.

Q: What is Setu Patolia's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Pulmonary Disease, with taxonomy code 207RP1001X.

Q: When was this NPI record last updated?

The NPPES record for Setu Patolia was last updated on June 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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 January 21, 2009PECOS EnrolledAccepts Medicare Assignment

81.57/100

CMS Quality Rating

3660 VISTA AVE STE 202, SAINT LOUIS, MO 63110(314) 577-8000 Get Directions Write a Review

NPPES record last updated: June 18, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Setu Patolia NPPES

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

SETU PATOLIA (NPI 1649418104) is an individual pulmonary disease provider in Saint Louis, Missouri, licensed in Missouri (2013002818) and active in the NPI registry since January 2009. He is enrolled in Medicare PECOS, is affiliated with Ssm Health Saint Louis University Hospital, and maintains a secondary practice location in Saint Louis.

NPPES Registry Identity

NPI1649418104

Entity TypeIndividualMale

Primary Taxonomy207RP1001X

Provider Legal NameSETU PATOLIA

Location Address3660 VISTA AVE STE 202Saint Louis, MO 63110-2540

Mailing Address3660 Vista Ave Ste 202Saint Louis, MO 63110-2540

Phone(314) 577-8000

Sole ProprietorNo

Medical School CMSOtherGraduated 2005

Enumeration DateJanuary 21, 2009

Last NPPES UpdateJune 18, 2025

NPPES CertifiedJune 18, 2025

✔ NPI 1649418104 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal Medicine · Pulmonary DiseaseAllopathic & Osteopathic Physicians

Taxonomy Code207RP1001X

License✔ Licensed in MO · 2013002818

Definition

An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.

Also ListedInternal MedicineTaxonomy 207R00000X · License 2013002818 (MO)

Also ListedInternal Medicine · Critical Care MedicineTaxonomy 207RC0200X · License 2013002818 (MO)

3660 VISTA AVE STE 202, Saint Louis, MO 63110

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Secondary Practice Location 1

Location 11225 S Grand BlvdSaint Louis, MO 63104-1016 · Phone (314) 977-6190

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 Sunflower Health Plan 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

Setu Patolia 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 ID3274751623

PECOS Enrollment IDI20150715000052

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 15

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.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

133 services73 patients

Critical care, first 30-74 minutes 99291

Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.

48 services21 patients

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233

Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.

43 services31 patients

Test to determine lung volumes using sensors 94726

This test, called spirometry, measures lung capacity using sensors. You breathe into a mouthpiece attached to a device that records the amount and rate of air you inhale and exhale. It helps diagnose and monitor lung conditions.

32 services32 patients

Test to examine how well the lungs exchange gases 94729

This is a test called a pulmonary function test, which helps understand the efficiency of your lungs. It measures how much air your lungs can hold, how quickly you can move air in and out of your lungs, and how well your lungs put oxygen into and remove carbon dioxide from your blood.

30 services30 patients

Test to measure expiratory airflow and volume changes before and after medication administration 94060

This procedure measures how air flows in and out of your lungs. It's done before and after medication to see if the treatment improves your breathing. It's a simple, non-invasive test that involves breathing into a device called a spirometer.

29 services29 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.

25 services22 patients

Test for exercise-induced lung stress 94618

An exercise-induced lung stress test assesses how your lungs respond to physical activity. During the test, you'll exercise on a treadmill or stationary bike while your heart rate, breathing, blood pressure, and oxygen levels are monitored. This helps identify any abnormal lung responses to exercise.

21 services21 patients

Biopsy of lobe of lung using an endoscope, 1 lobe 31628

A lung biopsy is a procedure where a small piece of lung tissue is taken for testing. An endoscope, a flexible tube with a light and camera, is used. It's inserted through the mouth or nose, down the windpipe, and into one lobe of the lung.

20 services20 patients

Computer-assisted image-guided navigation of lung airways using an endoscope 31627

This procedure involves the use of a special camera, called an endoscope, and computer technology to create real-time images of your lung airways. This helps doctors navigate through your lungs accurately, aiding in diagnosis or treatment.

18 services18 patients

Exam of lung airways with diagnostic or therapeutic procedure on growths using an endoscope and ultrasound 31654

This procedure involves using a specialized instrument, called an endoscope, to examine the lung airways. An ultrasound is also used to get a clearer image of any growths. If necessary, the doctor can perform procedures to diagnose or treat these growths.

18 services18 patients

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

18 services18 patients

Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope 31629

A needle biopsy of windpipe cartilage, airway, or lung involves using a thin, flexible tube with a camera (endoscope) to access and collect tissue samples. This procedure helps doctors diagnose lung conditions or diseases effectively and safely.

13 services13 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.

13 services13 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.

11 services11 patients

Hospital Affiliations CMS Care Compare

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

Ssm Health Saint Louis University Hospital

Acute Care Hospitals · Saint Louis, MO

1/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number260105

Location3635 Vista AveSaint Louis, MO 63110 · St. Louis City County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 63110 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

$128.28 typical visit price

range $55.65 – $169.38

Typical copayment $32.07 (range $13.91 – $42.34)

Most-billed visit code 99204

Established Patient

$98.37 typical visit price

range $17.76 – $137.92

Typical copayment $24.59 (range $4.44 – $34.48)

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.

81.57/100

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

Scored as part of a group practice

Quality

76.09

Promoting Interoperability

100

Improvement Activities

Cost

54.28

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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 Setu Patolia's NPI number?

The NPI number for Setu Patolia is 1649418104. It was assigned to this individual provider in the NPPES registry on January 21, 2009.

Where is Setu Patolia located?

Setu Patolia practices at 3660 Vista Ave Ste 202, Saint Louis, MO 63110. The listed phone number is (314) 577-8000.

What is Setu Patolia's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Pulmonary Disease, with taxonomy code 207RP1001X.

Is Setu Patolia enrolled in Medicare?

Yes. Setu Patolia 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 Setu Patolia accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health and Ambetter from Sunflower Health Plan and 4 other insurers list Setu Patolia 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 Setu Patolia affiliated with any hospitals?

According to CMS data, Setu Patolia is affiliated with Ssm Health Saint Louis University Hospital.

When was this NPI record last updated?

The NPPES record for Setu Patolia was last updated on June 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.