2026 NPPES data Ophthalmology Physician NPI 1669766481 D.O.
Verify on CMS →

SETH FOX, D.O.

Ophthalmology Physician in ERIE, Pennsylvania. CMS National Plan and Provider Enumeration System profile including specialty classification, practice address, and Medicare prescribing data when reported.

Federal data — no proprietary rating. PlainDoctor publishes the actual CMS NPPES and Medicare records — NPI registration, specialty, practice location, and prescribing data — without a composite score or editorial opinion on top. Every field traces to a federal source.
Prescribing volume
1K
Medicare Part D claims · 345 beneficiaries · Ophthalmology Physician avg: 1K
Generic prescribing
58%
generic claims · 42% brand-name · higher generic rates reduce patient out-of-pocket costs
MIPS score
84.2377/100
▲ 1 pts above national avg 83.1 · [object Object]
Industry payments
$1.3K
43 payments · CMS Open Payments (Sunshine Act)

What the federal data shows

SETH FOX, D.O. reported a CMS MIPS final score of 84.2377/100 — above the 83.1 national average — and filed 1,066 Medicare Part D claims in 2023.

84.2377/100
MIPS score · +1 vs avg
1K
Part D claims, 2023
58%
generic prescribing
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.

SETH FOX, D.O.'s MIPS score vs every scored U.S. clinician

CMS Merit-based Incentive Payment System (MIPS) final score, 2023 — the federal quality measure

84 45th percentile higher than 45% of 477,587 scored providers

0–10: 8,684 scored providers (2%). Below this entry. 10–20: 3,008 scored providers (1%). Below this entry. 20–30: 3,069 scored providers (1%). Below this entry. 30–40: 2,746 scored providers (1%). Below this entry. 40–50: 2,928 scored providers (1%). Below this entry. 50–60: 5,882 scored providers (1%). Below this entry. 60–70: 13,906 scored providers (3%). Below this entry. 70–80: 118,074 scored providers (25%). Below this entry. 80–90: 129,887 scored providers (27%). This entry sits in this band. 90–100: 189,403 scored providers (40%). Above this entry. This provider 0 100 every MIPS-scored clinician, bucketed by value

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

Board certification likely (heuristic — not verified)

SETH FOX, D.O. practices in an ABMS-board-eligible specialty and shows active CMS Medicare participation + MIPS quality reporting — 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 SETH FOX, D.O.?

Near national average

NPI registry status

Active

Issued 06/09/2011

NPI 1669766481

Primary specialty

Ophthalmology Physician

Mid-sized

22,090 US NPIs in this specialty

Medicare Part D claims

1,066 25% vs specialty avg

2023 prescription claims

Specialty avg: 1,420

MIPS final score

84.2377/100 1.1377000000000095% pts

Above neutral band

vs 83.1 national avg

Specialty distribution in Pennsylvania

How Ophthalmology Physician compares to other specialties among Pennsylvania providers

Pennsylvania providers

Ophthalmology Physician share within Pennsylvania

1. Ophthalmology Physician42%2. Internal medicine21%3. Family medicine17%4. Surgical12%5. Pediatric8%
Ophthalmology Physician share within Pennsylvania

Medicare quality performance — MIPS

SETH FOX, D.O.'s 2023 MIPS final score plotted against the Ophthalmology Physician national average

Near national average
MIPS Final Score
84.2377/100
vs 83.1 national avg · 2023 performance year

MIPS final score (Ophthalmology Physician) — 84.2377/100 vs national avg 83.1

0%100%National avg83%84.2%
MIPS final score (Ophthalmology Physician) — 84.2377/100 vs national avg 83.1

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).

SETH FOX, D.O. appears in the CMS NPPES registry as a Ophthalmology Physician provider holding D.O. credentials at 128 WEST 12 ST, ERIE, PA, 16501, with a listed phone of (814) 452-2796. NPI 1669766481 was issued on 06/09/2011. Because NPPES data is self-reported by the provider and refreshed monthly, the address, phone, and specialty reflect what FOX most recently submitted to CMS rather than a vetted directory listing, which is why patients should always confirm the practice is still at this location before scheduling.

Medicare Part D records for calendar year 2023 show 1,066 prescription claims written by this provider, covering 345 Medicare beneficiaries and totaling roughly $609K in drug spend, split 42% brand-name and 58% generic by claim count. These figures capture only Medicare Part D — commercial insurance, Medicaid, and cash-pay prescriptions are not included, and any drug-beneficiary cell under 11 is suppressed by CMS for patient privacy. On the CMS Merit-based Incentive Payment System, this provider earned a Final Score of 84.2377/100 for the 2023 performance year (Quality 100, Cost 47.4591), compared with the national average of 83.1.

Ophthalmology Physician is a mid-sized specialty nationwide, with 22,090 enrolled providers across 56 states and an average of 1,420 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

128 WEST 12 ST
ERIE, PA 16501

Provider Details

NPI 1669766481
Specialty Ophthalmology Physician
Credentials D.O.
Gender Male
NPI Issued 06/09/2011

CMS Quality Score (MIPS)

Merit-based Incentive Payment System (MIPS) scores from CMS, 2023 performance year.

84.2377
Final Score
Avg: 83.1
100
Quality
47.4591
Cost

Reporting: Group practice

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 SETH FOX, D.O.. Source: openpaymentsdata.cms.gov.

Total received

$1.3K

Largest payer

Bausch & Lomb Americas Inc.

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 — Pennsylvania PA-BOM 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 ~45K Pennsylvania medical licensees in 2023 — they are NOT specific to SETH FOX, D.O.. To verify SETH FOX, D.O.'s current license status, search the PA-BOM public license lookup directly, or check the Federation of State Medical Boards (FSMB) verification service.

133
Total board actions, Pennsylvania 2023
Across 129 cases
2.96
Actions per 1,000 licensees
Pennsylvania statewide rate
probation
Most common action type
48 cases

PA-BOM 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 Pennsylvania disciplinary trends page. Cross-checked against FSMB U.S. Medical Regulatory Trends.

Brand vs generic prescribing mix · Above average

SETH FOX, D.O. — brand share 42.0%
Specialty average (est.)

42% brand-name claims vs 58% generic, on 1,066 2023 Medicare Part D claims.

The federal Medicare Part D Generic Dispensing Rate national benchmark sits near 90% generic / 10% brand for primary-care prescribers, per CMS Office of the Actuary 2024 estimates. Higher brand share is common in specialty prescribing where generic equivalents are not available.

Medicare Part D Prescribing Data

CMS Medicare Part D prescriber-level data for calendar year 2023.

1,066
Total Claims
$609K
Total Drug Cost
345
Medicare Beneficiaries

Prescribing Breakdown

30-Day Fills
1,522
Total Day Supply
39,620
Brand vs Generic
42% brand / 58% generic
Brand Drug Cost
$573K
Generic Drug Cost
$36K
Antibiotic Claims
12

Patient Demographics

Average Patient Age
74.2 years
Avg HCC Risk Score
1.12
Gender Split
63% female / 37% male
Age Distribution
<65: 21, 65-74: 170, 75-84: 116, 85+: 38

Top Prescribed Drugs (Medicare Part D)

Top drugs by claim count for calendar year 2023. Based on Medicare Part D data only.

What SETH FOX, D.O. prescribes most

Top Medicare Part D drugs by claim count, 2023

claims
Source CMS Medicare Part D Prescriber Public Use File As of 2023
Drug Claims
Prednisolone Acetate
225
Ketorolac Tromethamine
175
Moxifloxacin
Moxifloxacin Hcl
169
Latanoprost
77
Cyclosporine
49
Lumigan
Bimatoprost
45
Fluorometholone
36
Restasis
Cyclosporine
33
Neomycin-Polymyxin-Dexameth
Neomycin/Polymyxin B/Dexametha
32
Timolol Maleate
24

* Counts below 11 are suppressed by CMS for patient privacy. Generic names shown where available from CMS Part D data.

Ophthalmology Physician Overview

How SETH FOX, D.O. fits within the Ophthalmology Physician landscape nationally.

22,090
Ophthalmology Physician Providers in US
56
States with Ophthalmology Physician
1,420
Avg Claims per Provider

SETH FOX, D.O.'s 1,066 claims are below the specialty average of 1,420.

Nearby Ophthalmology Physician Providers in Pennsylvania

Other clinicians with the same primary specialty enrolled in Pennsylvania, drawn from the same CMS NPPES roster as FOX.

Compare Ophthalmology Physician nationally: see state-by-state distribution →

Frequently Asked Questions

What is SETH FOX, D.O.'s specialty?
SETH FOX, D.O. specializes in Ophthalmology Physician and practices in ERIE, Pennsylvania. Credentials: D.O..
How much does SETH FOX, D.O. prescribe under Medicare Part D?
In 2023, SETH FOX, D.O. wrote 1,066 Medicare Part D claims totaling $609K in drug costs for 345 beneficiaries.
What is SETH FOX, D.O.'s Medicare quality score?
SETH FOX, D.O. has a CMS MIPS Final Score of 84.2377/100 (Quality: 100, Cost: 47.4591). The national average MIPS Final Score is 83.1. Source: CMS Merit-based Incentive Payment System (MIPS) 2023.
Where is SETH FOX, D.O. located?
SETH FOX, D.O. is located at 128 WEST 12 ST, ERIE, PA, 16501. Phone: (814) 452-2796.
What is SETH FOX, D.O.'s NPI number?
SETH FOX, D.O.'s National Provider Identifier (NPI) is 1669766481, issued on 06/09/2011.
Does SETH FOX, D.O. prescribe more brand-name or generic drugs?
SETH FOX, D.O.'s prescribing is 42% brand-name and 58% generic drugs by claim count, with $573K in brand drug costs.
How many Ophthalmology Physician providers are there in the US?
There are 22,090 Ophthalmology Physician providers across 56 states in the US. The average Ophthalmology Physician provider writes 1,420 Medicare Part D claims per year.
What drugs does SETH FOX, D.O. prescribe most often?
Based on 2023 Medicare Part D data, SETH FOX, D.O.'s most frequently prescribed drugs include Prednisolone Acetate, Ketorolac Tromethamine, Moxifloxacin. This reflects Medicare Part D prescriptions only and does not include commercial insurance or other payer types.
Does SETH FOX, D.O. accept Medicare?
SETH FOX, D.O. appears in CMS Medicare data with 1,066 Part D claims and 345 Medicare beneficiaries in 2023. Contact the provider's office directly to confirm current Medicare enrollment and accepted plans.
How can I verify SETH FOX, D.O.'s credentials?
SETH FOX, D.O.'s NPI is 1669766481 with credentials D.O.. 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

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