SUDHEER R KARNATI MD
NPI 1811186596
Internal Medicine in Lufkin, TX

Medicare Participation & PECOS Enrollment Status

Sudheer Karnati is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Sudheer Karnati is enrolled in PECOS and is eligible to order or refer health care 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.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

• Is the provider registered in PECOS? Yes

• PECOS PAC ID: 7810948239

  What is the PECOS Associate Control ID?
  A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

• PECOS Enrollment ID: I20110523000462

  What is the Provider Enrollment ID?
  The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

• 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 to Order or Refer Part B Clinical Laboratory and Imaging: Yes

• Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

• Eligible to Order or Refer a Home Health Agency (HHA): Yes

• Eligible to Order or Refer Power Mobility Devices: Yes

Provider Referred Orders for Durable Medical Equipment, Devices & Supplies

The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.

Durable Medical Equipment

• DME-Other DME (DE017N)

  Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (HCPCS:A4253)

  16 DME suppliers used 80 Medicare Claims 188 Services Paid

• DME-Other DME (DE000N)

  Normal, low and high calibrator solution / chips (HCPCS:A4256)

  2 DME suppliers used 16 Medicare Claims 16 Services Paid

• DME-Medical/Surgical Supplies (DA000N)

  Lancets, per box of 100 (HCPCS:A4259)

  12 DME suppliers used 33 Medicare Claims 45 Services Paid

• DME-Medical/Surgical Supplies (DA000N)

  Adhesive remover, wipes, any type, each (HCPCS:A4456)

  3 DME suppliers used 21 Medicare Claims 320 Services Paid

• DME-Other DME (DE001N)

  Tubing with integrated heating element for use with positive airway pressure device (HCPCS:A4604)

  1 DME suppliers used 21 Medicare Claims 21 Services Paid

• DME-Other DME (DE000N)

  Administration set, with small volume nonfiltered pneumatic nebulizer, disposable (HCPCS:A7003)

  2 DME suppliers used 11 Medicare Claims 18 Services Paid

• DME-Other DME (DE001N)

  Full face mask used with positive airway pressure device, each (HCPCS:A7030)

  2 DME suppliers used 19 Medicare Claims 19 Services Paid

• DME-Other DME (DE001N)

  Face mask interface, replacement for full face mask, each (HCPCS:A7031)

  2 DME suppliers used 16 Medicare Claims 48 Services Paid

• DME-Other DME (DE001N)

  Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap (HCPCS:A7034)

  2 DME suppliers used 18 Medicare Claims 18 Services Paid

• DME-Other DME (DE001N)

  Headgear used with positive airway pressure device (HCPCS:A7035)

  2 DME suppliers used 23 Medicare Claims 23 Services Paid

• DME-Other DME (DE001N)

  Tubing used with positive airway pressure device (HCPCS:A7037)

  1 DME suppliers used 11 Medicare Claims 11 Services Paid

• DME-Other DME (DE001N)

  Filter, disposable, used with positive airway pressure device (HCPCS:A7038)

  2 DME suppliers used 31 Medicare Claims 172 Services Paid

• DME-Other DME (DE001N)

  Water chamber for humidifier, used with positive airway pressure device, replacement, each (HCPCS:A7046)

  2 DME suppliers used 16 Medicare Claims 16 Services Paid

• DME-Hospital Beds (DB000N)

  Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress (HCPCS:E0260)

  2 DME suppliers used 45 Medicare Claims 45 Services Paid

• DME-Oxygen and Supplies (DC000N)

  Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing (HCPCS:E0431)

  3 DME suppliers used 52 Medicare Claims 52 Services Paid

• DME-Other DME (DE005N)

  Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) (HCPCS:E0466)

  2 DME suppliers used 14 Medicare Claims 14 Services Paid

• DME-Other DME (DE000N)

  Nebulizer, with compressor (HCPCS:E0570)

  3 DME suppliers used 50 Medicare Claims 50 Services Paid

• DME-Other DME (DE001N)

  Continuous positive airway pressure (cpap) device (HCPCS:E0601)

  2 DME suppliers used 37 Medicare Claims 39 Services Paid

• DME-Oxygen and Supplies (DC002N)

  Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)

  3 DME suppliers used 95 Medicare Claims 95 Services Paid

• DME-Oxygen and Supplies (DC002N)

  Portable oxygen concentrator, rental (HCPCS:E1392)

  2 DME suppliers used 26 Medicare Claims 26 Services Paid

• DME-Wheelchairs (DD000N)

  Standard wheelchair (HCPCS:K0001)

  2 DME suppliers used 18 Medicare Claims 18 Services Paid

• DME-Wheelchairs (DD000N)

  Lightweight wheelchair (HCPCS:K0003)

  2 DME suppliers used 21 Medicare Claims 21 Services Paid

• DME-Other DME (DE017N)

  Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service (HCPCS:K0553)

  5 DME suppliers used 32 Medicare Claims 32 Services Paid

• DME-Other DME (DE000N)

  Pharmacy dispensing fee for inhalation drug(s); per 30 days (HCPCS:Q0513)

  5 DME suppliers used 43 Medicare Claims 43 Services Paid

Orthotic Devices

• DME-Orthotic Devices (DF010N)

  Ostomy belt, each (HCPCS:A4367)

  2 DME suppliers used 12 Medicare Claims 12 Services Paid

• DME-Orthotic Devices (DF010N)

  Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each (HCPCS:A4389)

  2 DME suppliers used 12 Medicare Claims 240 Services Paid

• DME-Orthotic Devices (DF010N)

  Ostomy skin barrier, pectin-based, paste, per ounce (HCPCS:A4406)

  2 DME suppliers used 12 Medicare Claims 48 Services Paid

• DME-Orthotic Devices (DF010N)

  Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each (HCPCS:A4414)

  1 DME suppliers used 12 Medicare Claims 240 Services Paid

• DME-Orthotic Devices (DF010N)

  Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each (HCPCS:A4425)

  1 DME suppliers used 11 Medicare Claims 220 Services Paid

Drugs Administered Through DME

• DME-Drugs Administered Through DME (DG006N)

  Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme (HCPCS:J7620)

  5 DME suppliers used 50 Medicare Claims 5675 Services Paid

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Administration of influenza virus vaccine

The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.

This service was performed 294 times for 291 patients

Annual depression screening, 15 minutes

An annual depression screening is a short, routine evaluation to check for signs of depression. It involves answering a series of questions about your feelings, thoughts, and behaviors. The process takes about 15 minutes and helps detect depression early for better management.

This service was performed 353 times for 353 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

This service was performed 338 times for 338 patients

Automated urinalysis test

An automated urinalysis test is a routine examination that checks your urine for various substances. It can help identify potential health issues such as kidney problems or diabetes. The test uses a machine to analyze a small urine sample, providing quick and accurate results.

This service was performed 92 times for 73 patients

Blood glucose (sugar) level

A blood glucose level test measures the amount of sugar in your blood. It's often used to monitor and manage conditions like diabetes. High or low levels can indicate a health issue. The test is usually done by pricking your finger for a small blood sample.

This service was performed 649 times for 364 patients

Blood test, clotting time

A clotting time blood test helps determine how quickly your blood forms clots, a process crucial to stop bleeding. During the test, a small blood sample is taken from your arm. The sample is then analyzed in a lab to see how long it takes for a clot to form.

This service was performed 105 times for 11 patients

Blood test, lipids (cholesterol and triglycerides)

A lipid panel is a blood test that measures fats and fatty substances, such as cholesterol and triglycerides. These substances are used by your body as a source of energy. High levels can lead to health issues, including heart disease.

This service was performed 651 times for 365 patients

Detection test by immunoassay with direct visual observation for influenza virus

This is a test that identifies the influenza virus in your body. It works by using an immunoassay, a method that detects the presence of the virus through an immune response. The results are directly observable, making it a quick and efficient way to diagnose flu.

This service was performed 44 times for 21 patients

Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19)

This is a test to detect COVID-19, the virus causing severe respiratory illness. It uses a method called immunoassay, which identifies the virus by its unique proteins. The test is directly observed for accuracy. It helps determine if you're currently infected.

This service was performed 76 times for 65 patients

Dxa bone density measurement of hip, pelvis, spine

A DXA bone density measurement is a simple, quick, and non-invasive procedure that assesses the strength of your bones. This test uses X-rays to measure the amount of minerals, mainly calcium, in the hip, pelvis, and spine. It helps in early detection of osteoporosis or other bone diseases.

This service was performed 15 times for 15 patients

Established patient office or other outpatient visit, 10-19 minutes

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

This service was performed 236 times for 122 patients

Established patient office or other outpatient visit, 20-29 minutes

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.

This service was performed 1,219 times for 424 patients

Established patient office or other outpatient visit, 30-39 minutes

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.

This service was performed 382 times for 272 patients

Influenza vaccine, quadrivalent derived from cell cultures

The quadrivalent influenza vaccine, derived from cell cultures, is a flu shot that protects against four different flu viruses. It's made in labs using cell cultures instead of eggs, making it a good option for those with egg allergies. It's a crucial tool in preventing the flu.

This service was performed 18 times for 18 patients

Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage

The quadrivalent inactivated influenza vaccine is a shot given to protect against four strains of the flu virus. This 0.5 ml dosage helps your body develop immunity to the virus. It's an important step in preventing flu-related complications.

This service was performed 281 times for 280 patients

Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment

An Initial Preventive Physical Examination, also known as a "Welcome to Medicare" visit, is a one-time, face-to-face visit during your first 12 months of Medicare enrollment. It includes a review of your health, as well as education and counseling about preventive services and further screenings.

This service was performed 17 times for 17 patients

Injection of drug or substance under skin or into muscle

This procedure involves administering medication directly under the skin or into a muscle. A small needle is used to inject the drug, allowing it to be absorbed quickly into the bloodstream. It's a common method for delivering a variety of medications.

This service was performed 122 times for 82 patients

Injection, dexamethasone sodium phosphate, 1 mg

Dexamethasone sodium phosphate is a medication given via injection. It is a type of steroid that helps reduce inflammation and immune responses. It can be used to treat a variety of conditions, such as allergies, skin conditions, arthritis, and more.

This service was performed 107 times for 74 patients

Injection, ketorolac tromethamine, per 15 mg

Ketorolac tromethamine is a medication administered through injection, often used to manage moderate to severe pain. Each 15 mg dose helps to reduce hormones causing inflammation and pain in the body. It is not recommended for long-term use.

This service was performed 46 times for 17 patients

Insertion of needle into vein for collection of blood sample

This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.

This service was performed 820 times for 393 patients

New patient office or other outpatient visit, 30-44 minutes

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

This service was performed 17 times for 17 patients

Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and

This is a service where a doctor or authorized practitioner certifies that you require Medicare-covered home health services. They will communicate with the home health agency and review reports on your health status to ensure you receive appropriate care. This does not involve an in-person visit.

This service was performed 29 times for 29 patients

Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians a

This procedure involves a doctor or approved practitioner reviewing your health status and re-certifying your need for Medicare-covered home health services. It includes communication with the home health agency and assessment of your health reports, even when you're not physically present.

This service was performed 53 times for 23 patients

Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report

An electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.

This service was performed 33 times for 31 patients

Transitional care management services for problem of high complexity

Transitional care management services are designed to ensure a smooth transition from a hospital to home or another care setting for patients with complex health issues. These services include medication management, patient education, and coordination with healthcare providers.

This service was performed 48 times for 43 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $31.6 for a new patient copayment and $24.26 for an established patient copayment.

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 75904 ZIP code area.

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Quality Reporting

The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. 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.

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical 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. Sudheer Karnati is affiliated with the following medical facilities:

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number

45D0961371

Facility Type

Physician Office

Certificate Effective Date

February 24, 2025

Certificate Expiration Date

February 23, 2027

Laboratory Director

SUDHEER R. KARNATI

Certificate Type

Certificate of Waiver

Certificate Type Description

This CLIA certificate is issued to Sudheer Karnati to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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