POOJA SETHI PATEL MD
NPI 1881985463
Ophthalmology in Hendersonville, NC

Q: What is Pooja Patel's NPI number?

The NPI number for Pooja Patel is 1881985463. It was assigned to this individual provider in the NPPES registry on April 29, 2011. The provider is also known as Pooja Sethi MD.

Q: What is Pooja Patel's specialty?

The primary specialty registered for this NPI is Ophthalmology with taxonomy code 207W00000X.

Q: When was this NPI record last updated?

The NPPES record for Pooja Patel was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years 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 April 29, 2011PECOS EnrolledAccepts Medicare Assignment

93.51/100

CMS Quality Rating

1701 OLD VILLAGE RD, HENDERSONVILLE, NC 28791(828) 693-1773(828) 692-3297 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 21, 2022, Jul 5, 2017 (2 updates tracked since 2017).

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About Pooja Sethi Patel Md NPPES

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

POOJA SETHI PATEL MD (NPI 1881985463) is an individual ophthalmology provider in Hendersonville, North Carolina, licensed in North Carolina (2017-01208) and active in the NPI registry since April 2011. She is enrolled in Medicare PECOS and is a graduate of Tulane University School Of Medicine (2011).

NPPES Registry Identity

NPI1881985463

Entity TypeIndividualFemale

Primary Taxonomy207W00000X

Provider Legal NamePOOJA SETHI PATELCredential: MD

Location Address1701 OLD VILLAGE RDHendersonville, NC 28791-3772

Mailing Address1701 Old Village RdHendersonville, NC 28791-3772 · (828) 693-1773 · Fax (828) 692-3297

Phone(828) 693-1773

Fax(828) 692-3297

Sole ProprietorNo

Medical School CMSTulane University School Of MedicineGraduated 2011

Enumeration DateApril 29, 2011

Last NPPES UpdateJuly 21, 20222 updates tracked since enumeration

✔ NPI 1881985463 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOphthalmologyAllopathic & Osteopathic Physicians

Taxonomy Code207W00000X

License✔ Licensed in NC · 2017-01208

Definition

An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.

1701 OLD VILLAGE RD, Hendersonville, NC 28791

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Other Names 1

Former Name (1)Pooja Sethi Md

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter of North Carolina, AmeriHealth Caritas Next 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

Pooja Sethi Patel 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 ID749595262

PECOS Enrollment IDI20170731001065

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 14

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.

774 services593 patients

Imaging of retina 92134

Imaging of the retina is a non-invasive procedure that captures detailed images of your eye's interior. This helps detect conditions like macular degeneration or retinal detachment. It's painless and takes only a few minutes.

637 services584 patients

Imaging of optic nerve 92133

Imaging of the optic nerve is a non-invasive procedure that captures detailed pictures of your optic nerve. It helps doctors assess eye health, particularly for conditions like glaucoma. It's painless, quick, and uses safe technology like MRI or OCT (Optical Coherence Tomography).

304 services217 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.

297 services265 patients

Measurement of corneal curvature and depth of eye 92136

This procedure measures the shape and depth of your eye, specifically the cornea, the clear front surface. It helps in diagnosing conditions, planning for surgeries, or fitting contact lenses. It's non-invasive and painless.

223 services156 patients

Removal of cataract with insertion of prosthetic lens 66984

This is a procedure where a cloudy lens in your eye, known as a cataract, is removed. After removal, a clear artificial lens is inserted. This helps to restore your vision, enabling you to see clearly again.

199 services112 patients

Established patient complete exam of visual system 92014

An established patient complete exam of the visual system involves a thorough check of your eyes and vision. It assesses eye health, checks for diseases, and measures your ability to see clearly at different distances. It's a routine, non-invasive procedure.

187 services187 patients

Exam of visual field with extended testing 92083

An extended visual field exam is a detailed test to evaluate your peripheral (side) vision. It helps to detect any potential blind spots which may not be noticeable in daily life. These could be caused by eye diseases like glaucoma, or neurological conditions.

149 services145 patients

Removal of cataract with insertion of prosthetic lens 66984

113 services12 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.

97 services97 patients

Removal of recurring cataract in lens capsule using a laser 66821

This procedure, known as YAG laser capsulotomy, treats cloudiness in the lens capsule following cataract surgery. A laser is used to create a small hole in the cloudy capsule, allowing light to pass through and restore clear vision. It's a quick, painless procedure.

88 services69 patients

Photography of the retina 92250

Photography of the retina, also known as retinal imaging, is a non-invasive procedure that captures images of the back of your eye. This helps doctors identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. It's painless and quick, often part of a routine eye exam.

87 services87 patients

Exam of the internal drainage system of eye 92020

This is a procedure where your doctor examines the eye's internal drainage system, essential for maintaining eye pressure. They use specialized tools to check for blockages or damage that might lead to conditions like glaucoma. It's non-invasive and painless.

19 services18 patients

Exam to measure eye deviation and range of motion 92060

This is an eye exam that checks for any misalignment in your eyes, also known as deviation. It also assesses the movement range of your eyes. The procedure is painless and helps in detecting conditions like strabismus or other vision issues.

14 services12 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 28791 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

$125.01 typical visit price

range $54.12 – $165.09

Typical copayment $31.25 (range $13.53 – $41.27)

Most-billed visit code 99204

Established Patient

$67.72 typical visit price

range $17.21 – $134.61

Typical copayment $16.93 (range $4.30 – $33.65)

Most-billed visit code 99213

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.

93.51/100

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

Scored through an Alternative Payment Model

Quality

84.23

Promoting Interoperability

100

Improvement Activities

Reported Quality Measures

Complications After Cataract Surgery

Lower rates are better for this measure.

1%327 patients

Diabetes: Eye Exam

98%303 patients4/55-star benchmark: 100%

Glaucoma Intraocular Pressure Reduction

89%127 patients

Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation

58%168 patients

Use of High-Risk Medications in Older Adults

Lower rates are better for this measure.

Patients appropriateDiagnosis: 0% · 1,795 patients

Patients totalRate: 0% · 1,795 patients

0%1,795 patients5/55-star benchmark: 100%

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 3

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

Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens V2303

Other-Vision, Hearing, and Speech Services · category OC000N

1 supplier12 claims24 services$46.77 avg. paid by Medicare

Prism, per lens V2715

Other-Vision, Hearing, and Speech Services · category OC000N

1 supplier12 claims24 services$9.69 avg. paid by Medicare

U-v lens, per lens V2755

Other-Vision, Hearing, and Speech Services · category OC000N

1 supplier13 claims26 services$13.47 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 8

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

FARID MANSOOR KHAN MD

Ophthalmology (Retina Specialist)