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DR. CLAY A CAUTHEN MD
NPI 1730396862
Internal Medicine - Advanced Heart Failure and Transplant Cardiology in Austin, TX

Active since May 17, 2007PECOS EnrolledAccepts Medicare Assignment
72.52/100
CMS Quality Rating
1301 W 38TH ST, SUITE 514, AUSTIN, TX 78705(512) 681-0500(512) 681-0501 Get Directions Write a Review

NPPES record last updated: May 14, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Dr. Clay A Cauthen Md NPPES

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

DR. CLAY A CAUTHEN MD (NPI 1730396862) is an individual advanced heart failure and transplant cardiology provider in Austin, Texas, licensed in Texas (P7256) and active in the NPI registry since May 2007. He is enrolled in Medicare PECOS, is affiliated with Ascension Seton Medical Center Austin, and is a graduate of Other (2005).

NPPES Registry Identity

NPI1730396862
Entity TypeIndividualMale
Primary Taxonomy207RA0001X
Provider Legal NameDR. CLAY A CAUTHENCredential: MD
Location Address1301 W 38TH ST, SUITE 514Austin, TX 78705-1000
Mailing Address1400 N Ih 35, Suite 300Austin, TX 78701-1926 · (512) 324-8300 · Fax (512) 324-8301
Phone(512) 681-0500
Fax(512) 681-0501
Sole ProprietorNo
Medical School CMSOtherGraduated 2005
Enumeration DateMay 17, 2007
Last NPPES UpdateMay 14, 2025
NPPES CertifiedMay 14, 2025
✔ NPI 1730396862 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Advanced Heart Failure and Transplant CardiologyAllopathic & Osteopathic Physicians
Taxonomy Code207RA0001X
License✔ Licensed in TX · P7256
Definition
Specialists in Advanced Heart Failure and Transplant Cardiology would participate in the inpatient and outpatient management of patients with advanced heart failure across the spectrum from consideration for high-risk cardiac surgery, cardiac transplantation, or mechanical circulatory support, to pre-and post-operative evaluation and management of patients with cardiac transplants and mechanical support devices, and end-of-life care for patients with end-stage heart failure.
1301 W 38TH ST, Austin, TX 78705
Open in Google Maps ↗

Other Identifiers 6

Medicaid322658103TX
Other8DW486TX · Bcbs
Medicaid322658104TX
Medicaid322658102TX
Medicaid322658101TX
Other8ET194TX · Bcbs

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections 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

Dr. Clay A Cauthen 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 ID2668537796
PECOS Enrollment IDI20130904000902
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 9

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 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.
142 services75 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.
119 services40 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.
116 services33 patients
Evaluation of lower heart chamber assist device 93750
An evaluation of a lower heart chamber assist device is a procedure to check the function of an implanted device aiding your heart's lower chambers. This helps ensure optimal heart function by monitoring the device's performance and your heart's response to it.
79 services12 patients
Ultrasound of heart with color-depicted blood flow, rate, direction and valve function 93306
This is a heart ultrasound, also known as an echocardiogram. It uses sound waves to create pictures of your heart, showing how blood flows through it. The color depicts the blood flow's speed and direction. It also checks the heart's valves to ensure they're working properly.
66 services46 patients
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
31 services25 patients

Hospital Affiliations CMS Care Compare 4

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

Ascension Seton Medical Center Austin

Acute Care Hospitals · Austin, TX
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number450056
Location1201 W 38th StAustin, TX 78705 · Travis County
Emergency services Birthing friendly

Ascension Seton Northwest

Acute Care Hospitals · Austin, TX
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number450867
Location11113 Research BoulevardAustin, TX 78759 · Travis County
Emergency services Birthing friendly

Ascension Seton Williamson

Acute Care Hospitals · Round Rock, TX
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number670041
Location201 Seton ParkwayRound Rock, TX 78664 · Williamson County
Emergency services Birthing friendly

Ascension Seton Hays

Acute Care Hospitals · Kyle, TX
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number670056
Location6001 Kyle PkwyKyle, TX 78640 · Hays County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 78705 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
$131.95 typical visit price
range $57.88 – $174.00
Typical copayment $32.98 (range $14.47 – $43.50)
Most-billed visit code 99204
Established Patient
$101.65 typical visit price
range $18.88 – $142.23
Typical copayment $25.41 (range $4.72 – $35.55)
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.

72.52/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality61.27
Promoting Interoperability100
Improvement Activities40
Cost47.12

Reported Quality Measures

Breast Cancer Screening
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
17%63 patients1/55-star benchmark: 92%
Cervical Cancer Screening
Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria: - Women age 21-64 who had cervical cytology performed every 3 years - Women age 30-64 who had cervical cytology/human papillomavirus (HPV)…
14%58 patients
Colorectal Cancer Screening
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
18%225 patients1/55-star benchmark: 85%
Documentation of Current Medications in the Medical Record
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.
100%946 patients5/55-star benchmark: 100%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
96%1,404 patients4/55-star benchmark: 99%
Health Information Exchange
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…
51%108 patients3/55-star benchmark: 88%
Medication Reconciliation
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.
94%120 patients3/55-star benchmark: 100%
Patient-Specific Education
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.
45%338 patients2/55-star benchmark: 97%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
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…
22%328 patients1/55-star benchmark: 97%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Patients screenedForUse: 93% · 231 patients
87%231 patients4/55-star benchmark: 98%
Provide Patient Access
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…
86%338 patients4/55-star benchmark: 100%
Secure Messaging
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…
45%338 patients3/55-star benchmark: 89%
View, Download, or Transmit (VDT)
At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period.
48%338 patients
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 6

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

Tacrolimus, immediate release, oral, 1 mg J7507
Treatment-Treatment - Miscellaneous · category RX029N
4 suppliers58 claims5,595 services$0.30 avg. paid by Medicare
Prednisone, immediate release or delayed release, oral, 1 mg J7512
Treatment-Treatment - Miscellaneous · category RX029N
2 suppliers13 claims2,700 services$0.01 avg. paid by Medicare
Mycophenolate mofetil, oral, 250 mg J7517
Treatment-Treatment - Miscellaneous · category RX029N
5 suppliers58 claims8,040 services$0.20 avg. paid by Medicare
Sirolimus, oral, 1 mg J7520
Treatment-Treatment - Miscellaneous · category RX029N
3 suppliers21 claims1,695 services$2.62 avg. paid by Medicare
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period Q0511
Treatment-Chemotherapy · category RH012N
7 suppliers67 claims67 services$18.36 avg. paid by Medicare
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period Q0512
Treatment-Chemotherapy · category RH012N
6 suppliers75 claims82 services$12.32 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.

WILLIAM R WOODWARD MD
Specialist
1301 W 38TH ST, SUITE 601
AUSTIN, TX 78705
Travis County (512) 454-5171
TEXAS CARDIOVASCULAR CONSULTANTS, PA
Internal Medicine (Cardiovascular Disease)
1301 W 38TH ST, SUITE 705
AUSTIN, TX 78705
Travis County (512) 617-6000
DR. KEVIN J. BOZIC MD
Orthopaedic Surgery
1301 W 38TH ST, STE 102
AUSTIN, TX 78705
Travis County (512) 454-4561
MEGAN LYN MCCOIN MD
Obstetrics & Gynecology
1301 W 38TH ST, SUITE 300
AUSTIN, TX 78705
Travis County (512) 454-5721
AMANDA MAEGHAN HERRERA LCSW-S
Social Worker (Clinical)
1301 W 38TH ST
AUSTIN, TX 78705
Travis County (512) 324-3380
MARK J PIRWITZ MD, FACC
Internal Medicine (Interventional Cardiology)
1301 W 38TH ST, SUITE 400
AUSTIN, TX 78705
Travis County (512) 324-3440
MATTHEW C ROBINSON M.D.
Internal Medicine (Infectious Disease)
1301 W 38TH ST, SUITE 403
AUSTIN, TX 78705
Travis County (512) 459-0301
ZAHIR A MOMIN MD
Internal Medicine
1301 W 38TH ST, #205
AUSTIN, TX 78705
Travis County (512) 324-1864

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 Clay Cauthen's NPI number?

The NPI number for Clay Cauthen is 1730396862. It was assigned to this individual provider in the NPPES registry on May 17, 2007.

Where is Clay Cauthen located?

Clay Cauthen practices at 1301 W 38th St Suite 514, Austin, TX 78705. The listed phone number is (512) 681-0500.

What is Clay Cauthen's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Advanced Heart Failure and Transplant Cardiology, with taxonomy code 207RA0001X.

Is Clay Cauthen enrolled in Medicare?

Yes. Clay Cauthen 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 Clay Cauthen accept?

Health plans from Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 3 other insurers list Clay Cauthen 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 Clay Cauthen affiliated with any hospitals?

According to CMS data, Clay Cauthen is affiliated with Ascension Seton Medical Center Austin, Ascension Seton Northwest, Ascension Seton Williamson and Ascension Seton Hays.

When was this NPI record last updated?

The NPPES record for Clay Cauthen was last updated on May 14, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.