Active NPI 1609835115 Individual Practitioner Male Practitioner

Dr. Michael P Sumida , MD

Surgery • Athens, TN

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Michael Sumida, MD is a certified Surgery practicing in Athens, TN. With approximately 32 years of clinical experience since graduating from University Of Kentucky College Of Medicine in 1994, Dr. Sumida delivers high-quality medical care to the local community at 719 COOK DR.

Dr. Sumida is affiliated with Advanced Diagnostic Imaging Pc and accepts Medicare assignment.

Frequently performed procedures and clinical services include new patient outpatient office visit, established patient outpatient office visit, biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

719 Cook Dr
Ste 109

Athens, TN 373033495

Telephone 4237452344

Fax 4237452314

Associated Practice Facility / Clinic

🏢 Athens Physicians Practice, Llc Facility NPI 1689055774

Medicare Profile & Education

Medical School

University Of Kentucky College Of Medicine

Graduation Year

1994

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Surgery in Athens, TN

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

32 Yrs +3.7 yrs vs City Avg

City Avg: 28.3 Yrs

State Avg: 26.3 Yrs

Regional Practice Density

5 Specialists

Practicing in Athens, TN (682 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

79.1% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Sumida (32 Years) 32 Yrs

Athens Specialty Average (28.3 Years) 28.3 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	120	120	$467.52	$151.46
99213 Established patient office or other outpatient visit, typically 15 minutes	91	80	$212.37	$82.20
43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope	41	41	$635.36	$75.04
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	36	34	$309.27	$117.73
45378 Diagnostic exam of large bowel using a flexible endoscope	28	28	$923.00	$161.97
G0105 Colorectal cancer screening; colonoscopy on individual at high risk	24	24	$923.00	$165.31
45384 Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery	24	24	$1155.38	$176.27
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	12	12	$304.65	$101.93

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	68	68	$467.52	$153.64
99213 Established patient office or other outpatient visit, typically 15 minutes	66	58	$212.37	$83.36
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	62	62	$304.65	$103.34
45378 Diagnostic exam of large bowel using a flexible endoscope	59	59	$1012.11	$166.30
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	48	39	$309.27	$116.67
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	43	28	$127.56	$51.85
43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope	32	32	$898.47	$85.49
45384 Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery	26	26	$1253.28	$180.46

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	100	80	$204.90	$83.61
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	97	97	$288.25	$101.86
45378 Diagnostic exam of large bowel using a flexible endoscope	44	44	$1370.85	$171.17
43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope	35	35	$1394.84	$86.33
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	27	23	$114.21	$51.67
45384 Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery	21	21	$1796.35	$160.61
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	15	11	$183.23	$67.00
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	14	14	$467.52	$155.85
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	11	11	$309.27	$120.04

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	90	90	$204.58	$105.40
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	62	55	$85.40	$52.67
99213 Established patient office or other outpatient visit, typically 15 minutes	56	47	$143.13	$85.98
45378 Diagnostic exam of large bowel using a flexible endoscope	53	53	$1070.19	$174.64
43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope	37	37	$904.59	$95.23
45384 Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery	19	19	$1373.21	$195.81
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	12	12	$345.42	$189.29

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	89	69	$126.28	$67.73
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	85	85	$187.29	$97.32
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	43	41	$82.67	$40.77
45378 Diagnostic exam of large bowel using a flexible endoscope	35	34	$1070.00	$168.92
43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope	27	27	$918.70	$94.82
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	21	18	$316.29	$186.61
45384 Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery	20	20	$1383.50	$201.98
47562 Removal of gallbladder using an endoscope	13	13	$3110.00	$599.40

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	227	150	$95.00	$65.95
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	127	127	$155.00	$97.93
43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope	53	52	$900.00	$94.94
45378 Diagnostic exam of large bowel using a flexible endoscope	40	40	$1070.00	$172.51
45384 Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery	37	37	$1400.00	$207.10
G0105 Colorectal cancer screening; colonoscopy on individual at high risk	22	22	$1070.00	$157.84
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	17	17	$310.00	$185.83
47562 Removal of gallbladder using an endoscope	14	14	$3245.00	$561.78

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	155	117	$95.00	$64.25
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	123	123	$155.00	$93.80
45384 Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery	44	44	$1400.00	$204.85
43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope	44	43	$881.59	$81.58
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	40	38	$60.00	$38.40
45378 Diagnostic exam of large bowel using a flexible endoscope	34	34	$1070.00	$168.47
G0105 Colorectal cancer screening; colonoscopy on individual at high risk	31	31	$1070.00	$167.41
99231 Follow-up hospital inpatient care per day, typically 15 minutes	21	14	$95.00	$34.94
G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk	21	21	$1070.00	$167.22
17000 Destruction of skin growth	20	19	$110.00	$57.82
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	18	14	$128.89	$65.16
47562 Removal of gallbladder using an endoscope	14	14	$3110.00	$540.70
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	14	14	$310.71	$181.46

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	114	114	$155.00	$93.23
99213 Established patient office or other outpatient visit, typically 15 minutes	94	77	$95.00	$63.27
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	70	67	$60.00	$37.70
43239 Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope	57	57	$900.00	$96.68
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	35	35	$310.00	$179.52
G0105 Colorectal cancer screening; colonoscopy on individual at high risk	33	33	$1070.15	$164.97
G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk	29	29	$1070.00	$165.34
45378 Diagnostic exam of large bowel using a flexible endoscope	25	25	$1070.00	$161.79
99231 Follow-up hospital inpatient care per day, typically 15 minutes	24	15	$95.00	$34.78
45384 Removal of polyps or growths of large bowel using a flexible endoscope with electrical cautery	23	23	$1400.00	$205.26
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	22	13	$130.23	$64.13
47562 Removal of gallbladder using an endoscope	11	11	$3100.91	$569.90

Medical Specialties & State Licenses

Surgery Primary Specialty

NUCC Taxonomy Code: 208600000X

State License TN MD27304

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

3096585 (TN)

Commercial Insurance / Payer ID Blue Cross Blue Shield

3146634 (TN)

Hospital & Practice Group Affiliations

Advanced Diagnostic Imaging Pc

3024 Business Park Cir, Goodlettsville, TN 370723132

Phone: 6158516033

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners

Dr. Nicholas Ballay , MD

Surgery

NPI 1295093052

Doctor of Medicine (M.D.)

Dr. Preston Brown , MD

Surgery

NPI 1306806112

Doctor of Medicine (M.D.)

Dr. Thomas Layman , MD

Surgery

NPI 1417917212

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active March 01, 2010

NPI status registered as active in NPPES database

📍

Updated Practice Location March 01, 2010

Registered at 719 COOK DR, STE 109, ATHENS, TN 373033495 (Tel: 4237452344)

📍

Updated Business Mailing Address March 01, 2010

Registered at PO BOX 667, ETOWAH, TN 373310667 (Tel: 4237452344)

👤

Provider Name / Credentials Updated March 01, 2010

Recorded as MICHAEL SUMIDA, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) March 01, 2010

Surgery (License #MD27304 in TN)

🟢

Initial NPI Registration & Enumeration March 22, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1609835115

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: March 22, 2006

Last Update: March 01, 2010

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

Po Box 667

Etowah, TN 373310667

Phone: 4237452344

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.