NPI registry status
Active
2026 NPPES data Facial Plastic Surgery Physician NPI 1063419232 MD
Verify on CMS → Gavin Setzen, MD
Facial Plastic Surgery Physician in Albany, New York.
This profile is drawn from the federal National Provider Identifier Registry (CMS NPPES), which lists more than 7 million U.S. healthcare providers - including 614 in Facial Plastic Surgery Physician, and covers specialty classification, practice address, and Medicare Part D prescribing data when reported. According to CMS, every field reflects the provider's official federal registration, see our methodology.
Federal data, no proprietary rating.
We show these CMS records as-is - no composite score, no star rating, no editorial opinion layered on top.
Prescribing volume
3K
Medicare Part D claims · 671 beneficiaries · Facial Plastic Surgery Physician avg: 428
MIPS score
80.8/100
▼ 2 pts below national avg 83.1 · Above neutral
Industry payments
$66.5K
44 payments · CMS Open Payments (Sunshine Act)
Compiled from official public sources by the PlainDoctor editorial team.
What the federal data shows
Gavin Setzen, MD reported a CMS MIPS final score of 80.8/100 - below the 83.1 national average - and filed 2,568 Medicare Part D claims in 2023.
- 80.8/100
- MIPS score · -2 vs avg
- 3K
- Part D claims, 2023
- Likely
- board-certified (heuristic)
Every figure on this page comes straight from federal CMS records (NPPES, Medicare Part D, MIPS, Open Payments) - no proprietary rating or editorial opinion is applied.
Gavin Setzen, MD's MIPS score vs every scored U.S. clinician
CMS Merit-based Incentive Payment System (MIPS) final score, 2023, the federal quality measure
81 33rd percentile higher than 33% of 477,587 scored providers
Each bar is a band; taller bars hold more scored providers. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Merit-based Incentive Payment System (MIPS) · 2023
Where Gavin Setzen, MD sits
This provider among facial plastic surgery physician peers
Across the 160 facial plastic surgery physician providers who report both Medicare Part D prescribing and a MIPS quality score, Gavin Setzen, MD writes more Part D claims than 97% of them and scores higher on MIPS quality than 38% - placing this provider in the high-volume, lower-quality quadrant. Volume reflects patient-panel size and specialty, not quality; the two axes are independent.
Part D claim volume vs MIPS quality, by specialty percentile
Each dot is one facial plastic surgery physician peer from a representative sample of 60; the gold marker is Gavin Setzen, MD. Source: CMS Medicare Part D Prescriber data and the CMS Merit-based Incentive Payment System, 2023.
✓
Board certification likely (heuristic, not verified)
Gavin Setzen, MD practices in an ABMS-board-eligible specialty and shows active CMS Medicare participation + MIPS quality reporting + 1 hospital affiliation - signals consistent with board-certified status. For verified board certification, see CertificationMatters.org (the official ABMS public lookup).
What does the federal data show about Gavin Setzen, MD?
Near national averagePrimary specialty
Facial Plastic Surgery Physician
Medicare Part D claims
2,568 6× vs specialty avg
MIPS final score
80.8/100 2.3 pts vs avg
Specialty distribution in New York
How Facial Plastic Surgery Physician compares to other specialties among New York providers
Medicare quality performance, MIPS
Gavin Setzen, MD's 2023 MIPS final score plotted against the Facial Plastic Surgery Physician national average
- MIPS Final Score
- 80.8/100
- vs 83.1 national avg · 2023 performance year
MIPS final score (Facial Plastic Surgery Physician) - 80.8/100 vs national avg 83.1
How MIPS and board certification work
The Merit-based Incentive Payment System (MIPS) scores providers 0–100 across four performance categories: Quality, Cost, Promoting Interoperability, and Improvement Activities, weighted under 42 CFR §414.1380. Reporting is voluntary for many small practices, so absence of a MIPS score is not a quality signal.
Board certification through an ABMS or AOA member board signals voluntary post-licensure examination plus continuous Maintenance of Certification cycles. Verify any individual provider's status through certificationmatters.org (ABMS) or osteopathic.org (AOA).
Gavin Setzen, MD appears in the CMS NPPES registry as a Facial Plastic Surgery Physician provider holding MD credentials at 123 EVERETT RD, Albany, NY, 12205, with a listed phone of (518) 701-2000. NPI 1063419232 was issued on 07/03/2005.
Medicare Part D records for calendar year 2023 show 2,568 prescription claims written by this provider, covering 671 Medicare beneficiaries and totaling roughly $166K in drug spend, with an opioid prescribing rate of 0.4%. On the CMS Merit-based Incentive Payment System, this provider earned a Final Score of 80.8/100 for the 2023 performance year (Quality 74.6, Cost 63), compared with the national average of 83.1.
Facial Plastic Surgery Physician is a narrow specialty nationwide, with 614 enrolled providers across 47 states and an average of 428 Part D claims per prescriber, so the context for interpreting these metrics differs meaningfully from a primary-care baseline.
Important: PlainDoctor is a directory of publicly available government data, not medical advice, a malpractice database, or a quality rating. Inclusion here does not imply a recommendation, and absence of complaints or sanctions on this page does not mean none exist, always verify credentials through the NPPES NPI Registry, your state medical board, and the ABMS or AOA before making healthcare decisions.
Practice Address
Provider Details
| NPI | 1063419232 |
|---|---|
| Specialty | Facial Plastic Surgery Physician |
| Credentials | MD |
| Gender | Male |
| NPI Issued | 07/03/2005 |
CMS Quality Score (MIPS)
Merit-based Incentive Payment System (MIPS) scores from CMS, 2023 performance year.
80.7875
Final Score
Avg: 83.1
74.6194
Quality
63.0055
Cost
98
Promoting Interoperability
Reporting: Group practice
Hospital and facility affiliations
Facilities where Gavin Setzen, MD bills Medicare from. Star ratings (1-5) are CMS Hospital Compare's "Hospital overall rating" - a composite of mortality, readmission, patient experience, safety, timely care, and efficient use of medical imaging measures. Source: CMS Care Compare.
Albany Ent And Allergy Services PC
Albany, NY
Affiliations sourced from CMS Doctors and Clinicians National Downloadable File; hospital ratings from CMS Hospital General Information dataset (cross-referenced by facility name + state).
Industry payments received (2024) - CMS Open Payments transparency data
The federal Physician Payments Sunshine Act (part of the Affordable Care Act) requires drug and medical-device manufacturers + group purchasing organizations to publicly report payments and other transfers of value to physicians and teaching hospitals. The data below covers 2024 for Gavin Setzen, MD. Source: openpaymentsdata.cms.gov.
Total received
$66.5K
Largest payer
Stryker Corporation
Most common payment type
Food and Beverage
Industry payments are not necessarily indicators of bias, they include research funding, consulting fees for evidence-based work, royalties for inventions, food at conferences, and similar items. The disclosure exists for transparency. Read our methodology for how we interpret this data.
License & disciplinary context - New York NYSBPMC 2023 annual report
Aggregate state board data only, NOT a determination of any individual provider's status. The figures below describe statewide disciplinary activity across all ~100K New York medical licensees in 2023 - they are NOT specific to Gavin Setzen, MD. To verify Gavin Setzen, MD's current license status, search the NYSBPMC public license lookup directly, or check the Federation of State Medical Boards (FSMB) verification service.
312
Total board actions, New York 2023
Across 302 cases
3.12
Actions per 1,000 licensees
New York statewide rate
probation
Most common action type
89 cases
NYSBPMC publishes annual disciplinary statistics as part of public-record reporting under each state's Administrative Procedure Act. See the full breakdown by action type and year on the New York disciplinary trends page. Cross-checked against FSMB U.S. Medical Regulatory Trends.
Medicare Part D Prescribing Data
CMS Medicare Part D prescriber-level data for calendar year 2023.
2,568
Total Claims
$166K
Total Drug Cost
671
Medicare Beneficiaries
Prescribing Breakdown
- 30-Day Fills
- 5,747
- Total Day Supply
- 167,190
- Generic Drug Cost
- $85K
- Opioid Claims
- 11 (0.4% rate)
- Antibiotic Claims
- 25
Patient Demographics
- Average Patient Age
- 73.6 years
- Avg HCC Risk Score
- 1.03
- Gender Split
- 65% female / 35% male
- Age Distribution
- <65: 34, 65-74: 345, 75-84: 232, 85+: 60
Top Prescribed Drugs (Medicare Part D)
Top drugs by claim count for calendar year 2023. Based on Medicare Part D data only.
What Gavin Setzen, MD prescribes most
Top Medicare Part D drugs by claim count, 2023
- Famotidine
Famotidine
508 claims
- Omeprazole
Omeprazole
402 claims
- Fluticasone Propio…
Fluticasone Propionate
348 claims
- Montelukast Sodium
Montelukast Sodium
232 claims
- Ipratropium Bromide 165
Ipratropium Bromide
165 claims
- Budesonide 130
Budesonide
130 claims
- Azelastine Hcl 112
Azelastine Hcl
112 claims
- Pantoprazole Sodium 75
Pantoprazole Sodium
75 claims
| Drug | Claims |
|---|---|
| Famotidine | 508 |
| Omeprazole | 402 |
| Fluticasone Propionate | 348 |
| Montelukast Sodium | 232 |
| Ipratropium Bromide | 165 |
| Budesonide | 130 |
| Azelastine Hcl | 112 |
| Pantoprazole Sodium | 75 |
| Mupirocin | 55 |
| Levocetirizine Dihydrochloride | 49 |
* Counts below 11 are suppressed by CMS for patient privacy. Generic names shown where available from CMS Part D data.
Facial Plastic Surgery Physician Overview
How Gavin Setzen, MD fits within the Facial Plastic Surgery Physician landscape nationally.
614
Facial Plastic Surgery Physician Providers in US
47
States with Facial Plastic Surgery Physician
428
Avg Claims per Provider
Gavin Setzen, MD's 2,568 claims are above the specialty average of 428.
Nearby Facial Plastic Surgery Physician Providers in New York
Other clinicians with the same primary specialty enrolled in New York, drawn from the same CMS NPPES roster as Setzen.
Dr. Michel Abboud
MD
New York, NY
Dr. Manoj Abraham
M.D., F.A.C.S.
Poughkeepsie, NY
Dr. Stuart Arnold
MD
Manhasset, NY
Dr. Garrett Bennett
M.D.
New York, NY
Dr. Michael Bergstein
M.D.
Tarrytown, NY
Compare Facial Plastic Surgery Physician nationally: see state-by-state distribution →
Before you book an appointment
Use this federal record as your verification checklist, not as a recommendation.
- Confirm the NPI record is current in the official CMS registry, providers update their own NPPES details, and moves can lag. Verify this NPI
- Check the active license and any disciplinary history with the New York medical board, federal registration is not a license check. Credential verification guide
- Weigh a second option: compare this provider with a nearby Facial Plastic Surgery Physician peer on Medicare volume and prescribing patterns. Compare providers
Medicare Part D and MIPS figures describe practice patterns in federal programs only, they are not quality ratings, and PlainDoctor does not rate, rank, or recommend providers.
Healthcare Guides
Learn more about finding, verifying, and understanding healthcare providers.
How to Find a Doctor
Step-by-step guide to choosing a provider
Verify Credentials
Check NPI, board certification & license status
Medical Specialties Explained
Who treats what and how specialties differ
Understanding Medicare Claims Data
What prescribing data reveals about a provider
In-Network vs Out-of-Network
How insurance networks affect your costs
Telehealth Guide
Virtual care options and coverage in 2026
Explore New York
Frequently Asked Questions
What is Gavin Setzen, MD's specialty? ▼
Gavin Setzen, MD specializes in Facial Plastic Surgery Physician and practices in Albany, New York. Credentials: MD.
How much does Gavin Setzen, MD prescribe under Medicare Part D? ▼
In 2023, Gavin Setzen, MD wrote 2,568 Medicare Part D claims totaling $166K in drug costs for 671 beneficiaries.
What is Gavin Setzen, MD's Medicare quality score? ▼
Gavin Setzen, MD has a CMS MIPS Final Score of 80.8/100 (Quality: 74.6, Cost: 63). The national average MIPS Final Score is 83.1. Source: CMS Merit-based Incentive Payment System (MIPS) 2023.
Where is Gavin Setzen, MD located? ▼
Gavin Setzen, MD is located at 123 EVERETT RD, Albany, NY, 12205. Phone: (518) 701-2000.
What is Gavin Setzen, MD's NPI number? ▼
Gavin Setzen, MD's National Provider Identifier (NPI) is 1063419232, issued on 07/03/2005.
Does Gavin Setzen, MD prescribe opioids? ▼
Yes, Gavin Setzen, MD had 11 opioid claims in 2023 with an opioid prescribing rate of 0.4%.
How many Facial Plastic Surgery Physician providers are there in the US? ▼
There are 614 Facial Plastic Surgery Physician providers across 47 states in the US. The average Facial Plastic Surgery Physician provider writes 428 Medicare Part D claims per year.
What drugs does Gavin Setzen, MD prescribe most often? ▼
Based on 2023 Medicare Part D data, Gavin Setzen, MD's most frequently prescribed drugs include Famotidine, Omeprazole, Fluticasone Propionate. This reflects Medicare Part D prescriptions only and does not include commercial insurance or other payer types.
Does Gavin Setzen, MD accept Medicare? ▼
Gavin Setzen, MD appears in CMS Medicare data with 2,568 Part D claims and 671 Medicare beneficiaries in 2023. Contact the provider's office directly to confirm current Medicare enrollment and accepted plans.
How can I verify Gavin Setzen, MD's credentials? ▼
Gavin Setzen, MD's NPI is 1063419232 with credentials MD. You can verify this through the NPPES NPI Registry, check state medical board records, and confirm board certification through the ABMS or AOA.
Data Sources
View source datasets and methodology notes
- Provider Directory
- CMS National Plan and Provider Enumeration System (NPPES), download.cms.gov/nppes, updated monthly. Contains NPI, specialty, credentials, and practice location.
- Specialty Classification
- NUCC Health Care Provider Taxonomy (nucc.org), the industry standard for classifying provider specialties in Medicare and Medicaid billing.
- Prescribing Data
- CMS Medicare Part D Prescriber Public Use File (2023). Includes claims, drug costs, beneficiaries, and opioid prescribing rates.
- Quality Performance
- CMS Merit-based Incentive Payment System (MIPS) - 2023 performance year.
- Limitations
- Provider data is self-reported to CMS. Prescribing data reflects Medicare Part D only and does not include commercial insurance, Medicaid, or cash prescriptions. Claims below 11 beneficiaries are suppressed by CMS for privacy.
See our complete data methodology for details on how we collect and process government data.
Data as of April 2026 (NPPES) / 2023 (Medicare Part D). Source: Centers for Medicare & Medicaid Services (CMS).
Disclaimer: Data from CMS NPPES and Medicare Part D. PlainDoctor does not rate or rank providers. Provider information is self-reported and may not be current. Always verify information directly with the provider. About · Methodology
Compiled from official public sources by the PlainDoctor editorial team.
Every figure on PlainDoctor is rendered directly from the federal CMS NPPES registry, Medicare Part D, MIPS, and Open Payments records, no number is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error. Data current as of May 2026.