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DR. SUMAN KANT SETIA M.D.
NPI 1871560169
Family Medicine - Adult Medicine in Evergreen Park, IL

Active since March 05, 2006PECOS EnrolledAccepts Medicare Assignment
11.93/100
CMS Quality Rating
3900 W 95TH ST, #3, EVERGREEN PARK, IL 60805(708) 423-3242(708) 423-2856 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Suman Kant Setia M.d. NPPES

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

DR. SUMAN KANT SETIA M.D. (NPI 1871560169) is an individual adult medicine provider in Evergreen Park, Illinois and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS, is affiliated with Osf Little Company Of Mary Medical Center, and is a graduate of Other (1980).

NPPES Registry Identity

NPI1871560169
Entity TypeIndividualMale
Primary Taxonomy207QA0505X
Provider Legal NameDR. SUMAN KANT SETIACredential: M.D.
Location Address3900 W 95TH ST, #3Evergreen Park, IL 60805-1922
Mailing Address8940 Golden Oak CtHickory Hills, IL 60457-3202 · (708) 237-0667
Phone(708) 423-3242
Fax(708) 423-2856
Sole ProprietorNo
Medical School CMSOtherGraduated 1980
Enumeration DateMarch 5, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1871560169 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Adult MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QA0505X
Definition

The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.

3900 W 95TH ST, Evergreen Park, IL 60805
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter Health, Ambetter Health of Delaware.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. Suman Kant Setia 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 ID5991784209
PECOS Enrollment IDI20040719001018
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 10

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 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.
454 services161 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.
286 services143 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
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.
109 services109 patients
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212
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.
92 services40 patients
Advance care planning, first 30 minutes 99497
Advance care planning is a process where you discuss your healthcare preferences with your doctor. This conversation, lasting up to 30 minutes, helps ensure your wishes are respected if you're unable to communicate them in the future. It's about your care, your way.
76 services75 patients
Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allow G0181
This service involves a physician overseeing your care while you receive Medicare-covered services from a home health agency. The care you're receiving is complex and involves various disciplines. The physician isn't physically present but regularly supervises your treatment to ensure optimal health outcomes.
46 services18 patients

Hospital Affiliations CMS Care Compare 3

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

Osf Little Company Of Mary Medical Center

Acute Care Hospitals · Evergreen Park, IL
3/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number140179
Location2800 W 95th StEvergreen Park, IL 60805 · Cook County
Emergency services Birthing friendly

Advocate Christ Hospital & Medical Center

Acute Care Hospitals · Oak Lawn, IL
2/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number140208
Location4440 W 95th StreetOak Lawn, IL 60453 · Cook County
Emergency services Birthing friendly

Northwestern Medicine Central Dupage Hospital

Acute Care Hospitals · Winfield, IL
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140242
Location25 North Winfield RoadWinfield, IL 60190 · Du Page County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60805 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
$94.06 typical visit price
range $60.08 – $183.39
Typical copayment $23.51 (range $15.02 – $45.84)
Most-billed visit code 99203
Established Patient
$105.70 typical visit price
range $18.97 – $148.12
Typical copayment $26.42 (range $4.74 – $37.03)
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.

11.93/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Individually scored
Quality0
Improvement Activities0
Cost39.77

Referred Medical Equipment & Supplies CMS DME claims 8

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

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
29 suppliers79 claims246 services$6.01 avg. paid by Medicare
Normal, low and high calibrator solution / chips A4256
DME-Other DME · category DE000N
6 suppliers14 claims14 services$2.94 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
21 suppliers46 claims80 services$1.00 avg. paid by Medicare
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each A4430
DME-Orthotic Devices · category DF010N
2 suppliers16 claims300 services$7.31 avg. paid by Medicare
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
DME-Oxygen and Supplies · category DC002N
2 suppliers15 claims15 services$67.31 avg. paid by Medicare
Portable oxygen concentrator, rental E1392
DME-Oxygen and Supplies · category DC002N
2 suppliers11 claims11 services$32.27 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 14

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

QUALITY ASSURED HOME HEALTH INC
Home Health
3900 W 95TH ST, SUITE 9
EVERGREEN PARK, IL 60805
Cook County (708) 529-3823
OLIVER DRABKIN M.D. S.C.
Clinic/Center (Medical Specialty)
3900 W 95TH ST
EVERGREEN PARK, IL 60805
Cook County (708) 423-7550
MR. AHMED HASSAN MS,PT
Physical Therapist
3900 W 95TH ST, SUITE 1
EVERGREEN PARK, IL 60805
Cook County (708) 423-7900
MR. MOHAMED HASSAN MHS,PT
Physical Therapist
3900 W 95TH ST, SUITE 1
EVERGREEN PARK, IL 60805
Cook County (708) 423-7900
DR. OLIVER H DRABKIN M.D.
Dermatology
3900 W 95TH ST, STE 12
EVERGREEN PARK, IL 60805
Cook County (708) 423-7550
MAAME AMPONSAH D.C.
Chiropractor
3900 W 95TH ST
EVERGREEN PARK, IL 60805
Cook County (630) 920-4670
PREMIER PHYSICAL THERAPY PC
Physical Therapist
3900 W 95TH ST
EVERGREEN PARK, IL 60805
Cook County (630) 920-4670
MS. KRYSTYNA LARSON P.T., CLT
Physical Therapist
3900 W 95TH ST, SUITE 7
EVERGREEN PARK, IL 60805
Cook County (708) 423-7900

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 Suman Setia's NPI number?

The NPI number for Suman Setia is 1871560169. It was assigned to this individual provider in the NPPES registry on March 5, 2006.

Where is Suman Setia located?

Suman Setia practices at 3900 W 95th St #3, Evergreen Park, IL 60805. The listed phone number is (708) 423-3242.

What is Suman Setia's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Adult Medicine, with taxonomy code 207QA0505X.

Is Suman Setia enrolled in Medicare?

Yes. Suman Setia 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 Suman Setia accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Ambetter from Home State Health list Suman Setia 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 Suman Setia affiliated with any hospitals?

According to CMS data, Suman Setia is affiliated with Osf Little Company Of Mary Medical Center, Advocate Christ Hospital & Medical Center and Northwestern Medicine Central Dupage Hospital.

When was this NPI record last updated?

The NPPES record for Suman Setia was last updated on July 8, 2007. NPI Profile syncs with the weekly NPPES data releases published by CMS.