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SUMANA G SETTY MD
NPI 1710417563
Family Medicine in Boston, MA

Active since June 14, 2017PECOS EnrolledAccepts Medicare Assignment
1 BOSTON MEDICAL CENTER PLACE, DOWLING 5, BOSTON, MA 02118(617) 414-4465(617) 414-3345 Get Directions Write a Review

NPPES record last updated: February 7, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Feb 7, 2023, Aug 24, 2021, Jun 14, 2017 (3 updates tracked since 2017).

About Sumana G Setty Md NPPES

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

SUMANA G SETTY MD (NPI 1710417563) is an individual family medicine provider in Boston, Massachusetts, licensed in Massachusetts (285675) and active in the NPI registry since June 2017. She is enrolled in Medicare PECOS, is affiliated with Lawrence General Hospital, and maintains a secondary practice location in Lawrence.

NPPES Registry Identity

NPI1710417563
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NameSUMANA G SETTYCredential: MD
Location Address1 BOSTON MEDICAL CENTER PLACE, DOWLING 5Boston, MA 02118-2908
Mailing Address801 Albany Street, Fl GroundBoston, MA 02119-3791
Phone(617) 414-4465
Fax(617) 414-3345
Sole ProprietorNo
Medical School CMSNew York Medical CollegeGraduated 2017
Enumeration DateJune 14, 2017
Last NPPES UpdateFebruary 7, 20233 updates tracked since enumeration
NPPES CertifiedFebruary 7, 2023
✔ NPI 1710417563 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in MA · 285675
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
1 BOSTON MEDICAL CENTER PLACE, Boston, MA 02118
Open in Google Maps ↗

Secondary Practice Location 1

Location 134 Haverhill StLawrence, MA 01841-2884 · Phone (508) 851-0467

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.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

Sumana G Setty 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 ID8820368244
PECOS Enrollment IDI20210510001008
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 6

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.
84 services32 patients
Hospital discharge day management, 30 minutes or less 99238
Hospital discharge day management of 30 minutes or less includes finalizing your treatment, discussing your progress, and planning after-care at home. It ensures you're ready to leave the hospital and continue recovery safely.
17 services17 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.
16 services16 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.
15 services11 patients
Hospital discharge day management, more than 30 minutes 99239
Hospital discharge day management over 30 minutes involves a detailed process to ensure a smooth transition from hospital to home. It includes final examinations, discussion of your hospital stay, post-discharge instructions, and coordinating follow-up care.
13 services13 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.
12 services11 patients

Hospital Affiliations CMS Care Compare 2

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

Lawrence General Hospital

Acute Care Hospitals · Lawrence, MA
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220010
LocationOne General StreetLawrence, MA 01842 · Essex County
Emergency services Birthing friendly

Boston Medical Center

Acute Care Hospitals · Boston, MA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220031
Location1 Boston Medical Center PlaceBoston, MA 02118 · Suffolk County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 02118 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
$97.64 typical visit price
range $63.72 – $189.86
Typical copayment $24.41 (range $15.93 – $47.46)
Most-billed visit code 99203
Established Patient
$111.18 typical visit price
range $21.07 – $155.29
Typical copayment $27.79 (range $5.26 – $38.82)
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.

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.

ASA SAKARA PARIS CRNA
Nurse Anesthetist, Certified Registered
1 BOSTON MEDICAL CENTER PLACE
BOSTON, MA 02118
Suffolk County (617) 638-6950
BRIDGET N. BABICH-WYDYSH PA-C
Physician Assistant
1 BOSTON MEDICAL CENTER PLACE, C500
BOSTON, MA 02118
Suffolk County (617) 638-8609
MINELIA RODRIGUEZ-ORTIZ LMHC
Counselor (Mental Health)
1 BOSTON MEDICAL CENTER PLACE
BOSTON, MA 02118
Suffolk County (617) 414-5245
KEYWON WASHINGTON
Case Manager/Care Coordinator
1 BOSTON MEDICAL CENTER PLACE
BOSTON, MA 02118
Suffolk County (617) 638-6139
DANA H ROUS LICSW
Social Worker (Clinical)
1 BOSTON MEDICAL CENTER PLACE, DOWLING 9
BOSTON, MA 02118
Suffolk County (617) 414-5414
LOVERN R MOSELEY PHD
Psychologist (Clinical)
1 BOSTON MEDICAL CENTER PLACE
BOSTON, MA 02118
Suffolk County (617) 414-5245
JENNIFER G. PADRE LICSW
Social Worker (Clinical)
1 BOSTON MEDICAL CENTER PLACE
BOSTON, MA 02118
Suffolk County (617) 414-5245
SARAH FREDRIKSSON CRNA
Nurse Anesthetist, Certified Registered
1 BOSTON MEDICAL CENTER PLACE
BOSTON, MA 02118
Suffolk County (617) 638-6950

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 Sumana Setty's NPI number?

The NPI number for Sumana Setty is 1710417563. It was assigned to this individual provider in the NPPES registry on June 14, 2017.

Where is Sumana Setty located?

Sumana Setty practices at 1 Boston Medical Center Place Dowling 5, Boston, MA 02118. The listed phone number is (617) 414-4465.

What is Sumana Setty's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Sumana Setty enrolled in Medicare?

Yes. Sumana Setty 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 Sumana Setty accept?

Health plans from Anthem Blue Cross and Blue Shield list Sumana Setty 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 Sumana Setty affiliated with any hospitals?

According to CMS data, Sumana Setty is affiliated with Lawrence General Hospital and Boston Medical Center.

When was this NPI record last updated?

The NPPES record for Sumana Setty was last updated on February 7, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.