NPI registry status
Active
2026 NPPES data Adult Medicine Physician NPI 1871560169 M.D.
Verify on CMS → Suman Setia, M.D.
Adult Medicine Physician in Evergreen Park, Illinois.
This profile is drawn from the federal National Provider Identifier Registry (CMS NPPES), which lists more than 7 million U.S. healthcare providers - including 2,481 in Adult Medicine 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
9K
Medicare Part D claims · 394 beneficiaries · Adult Medicine Physician avg: 3K
Generic prescribing
86%
generic claims · 12% brand-name · higher generic rates reduce patient out-of-pocket costs
MIPS score
11.9/100
▼ 72 pts below national avg 83.5 · Penalty band
Source: CMS Medicare Part D Prescriber Public Use File, 2023
What the federal data shows
Suman Setia, M.D. reported a CMS MIPS final score of 11.9/100 - below the 83.5 national average - and filed 8,800 Medicare Part D claims in 2023.
- 11.9/100
- MIPS score · -72 vs avg
- 9K
- Part D claims, 2023
- 86%
- 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.
Suman Setia, M.D.'s MIPS score vs every measured U.S. clinician
CMS Merit-based Incentive Payment System (MIPS) final score, 2023, the federal quality measure. Clinicians whose score CMS assigned without scoring any category are excluded.
12 ≥ 2nd percentile 2% of 454,083 measured providers are in lower value bands
Each bar is a band; taller bars hold more measured 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.
The percentile is a conservative whole-score-point band: it counts only measured clinicians in lower score bands. A CMS MIPS metric is not a recommendation or a clinical-quality rating by PlainDoctor. See methodology § corpus placement.
Source CMS Merit-based Incentive Payment System (MIPS) · 2023
Where Suman Setia, M.D. sits
This provider among adult medicine physician peers
Across the 204 adult medicine physician providers who report both Medicare Part D prescribing and a MIPS quality score, Suman Setia, M.D. writes more Part D claims than 88% of them and scores higher on MIPS quality than 3% - placing this provider in the high-volume, lower-quality quadrant. Volume reflects patient-panel size and specialty, not quality; the two axes are independent.
Each dot is one adult medicine physician peer from a representative sample of 60; the gold marker is Suman Setia, M.D.. Source: CMS Medicare Part D Prescriber data and the CMS Merit-based Incentive Payment System, 2023.
✓
Board certification likely (heuristic, not verified)
Suman Setia, M.D. 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 Suman Setia, M.D.?
Below national averagePrimary specialty
Adult Medicine Physician
Medicare Part D claims
8,800 214% vs specialty avg
MIPS final score
11.9/100 71.6 pts vs avg
Specialty distribution in Illinois
How Adult Medicine Physician compares to other specialties among Illinois providers
Medicare quality performance, MIPS
Suman Setia, M.D.'s 2023 MIPS final score plotted against the Adult Medicine Physician national average
- MIPS Final Score
- 11.9/100
- vs 83.5 national avg · 2023 performance year
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).
Suman Setia, M.D. appears in the CMS NPPES registry as an Adult Medicine Physician provider holding M.D. credentials at 3900 W 95TH ST, Evergreen Park, IL, 60805, with a listed phone of (708) 423-3242. NPI 1871560169 was issued on 03/05/2006.
Medicare Part D records for calendar year 2023 show 8,800 prescription claims written by this provider, covering 394 Medicare beneficiaries and totaling roughly $926K in drug spend, split 12% brand-name and 86% generic by claim count, with an opioid prescribing rate of 2.7%. On the CMS Merit-based Incentive Payment System, this provider earned a Final Score of 11.9/100 for the 2023 performance year (Quality 0, Cost 39.8), compared with the 83.5 average among clinicians with a measured score.
Adult Medicine Physician is a narrow specialty nationwide, with 2,481 enrolled providers across 52 states and an average of 2,807 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 | 1871560169 |
|---|---|
| Specialty | Adult Medicine Physician |
| Credentials | M.D. |
| Gender | Male |
| NPI Issued | 03/05/2006 |
CMS Quality Score (MIPS)
Merit-based Incentive Payment System (MIPS) scores from CMS, 2023 performance year.
11.931
Final Score
Measured-score avg: 83.5
0
Quality
39.77
Cost
Reporting: Individual
License & disciplinary context - Illinois IDFPR 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 ~42K Illinois medical licensees in 2023 - they are NOT specific to Suman Setia, M.D.. To verify Suman Setia, M.D.'s current license status, search the IDFPR public license lookup directly, or check the Federation of State Medical Boards (FSMB) verification service.
106
Total board actions, Illinois 2023
Across 103 cases
2.52
Actions per 1,000 licensees
Illinois statewide rate
probation
Most common action type
38 cases
IDFPR 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 Illinois disciplinary trends page. Cross-checked against FSMB U.S. Medical Regulatory Trends.
Brand vs generic prescribing mix · Typical
Suman Setia, M.D. - brand share 12.0%
Adult Medicine Physician average
12% brand-name claims vs 86% generic, on 8,800 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.
8,800
Total Claims
$926K
Total Drug Cost
394
Medicare Beneficiaries
Prescribing Breakdown
- 30-Day Fills
- 19,634
- Total Day Supply
- 572,966
- Brand vs Generic
- 12% brand / 86% generic
- Brand Drug Cost
- $744K
- Generic Drug Cost
- $169K
- Opioid Claims
- 237 (2.7% rate)
- Antibiotic Claims
- 277
Patient Demographics
- Average Patient Age
- 70.9 years
- Avg HCC Risk Score
- 1.66
- Gender Split
- 59% female / 41% male
- Age Distribution
- <65: 62, 65-74: 210, 75-84: 82, 85+: 40
Top Prescribed Drugs (Medicare Part D)
Top drugs by claim count for calendar year 2023. Based on Medicare Part D data only.
What Suman Setia, M.D. prescribes most
Top Medicare Part D drugs by claim count, 2023
- Atorvastatin Calcium
Atorvastatin Calcium
488 claims
- Amlodipine Besylate
Amlodipine Besylate
390 claims
- Lisinopril
Lisinopril
296 claims
- Metformin Hcl
Metformin Hcl
256 claims
- Pantoprazole Sodium
Pantoprazole Sodium
254 claims
- Gabapentin
Gabapentin
246 claims
- Losartan Potassium
Losartan Potassium
245 claims
- Furosemide 186
Furosemide
186 claims
| Drug | Claims |
|---|---|
| Atorvastatin Calcium | 488 |
| Amlodipine Besylate | 390 |
| Lisinopril | 296 |
| Metformin Hcl | 256 |
| Pantoprazole Sodium | 254 |
| Gabapentin | 246 |
| Losartan Potassium | 245 |
| Furosemide | 186 |
| Metoprolol Succinate | 182 |
| Omeprazole | 176 |
* Counts below 11 are suppressed by CMS for patient privacy. Generic names shown where available from CMS Part D data.
Adult Medicine Physician Overview
How Suman Setia, M.D. fits within the Adult Medicine Physician landscape nationally.
2,481
Adult Medicine Physician Providers in US
52
States with Adult Medicine Physician
2,807
Avg Claims per Provider
Suman Setia, M.D.'s 8,800 claims are above the specialty average of 2,807.
Nearby Adult Medicine Physician Providers in Illinois
Other clinicians with the same primary specialty enrolled in Illinois, drawn from the same CMS NPPES roster as Setia.
Dr. James Achebe
MD
Chicago, IL
Dr. Lisa Babin
MD
Long Grove, IL
Dr. Walt Bajgrowicz
M.D.
Skokie, IL
Dr. Patricia Baltazar
FNP
New Lenox, IL
Delia Bedon
Oakbrook Terrace, IL
Compare Adult Medicine 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 Illinois medical board, federal registration is not a license check. Credential verification guide
- Weigh a second option: compare this provider with a nearby Adult Medicine 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.
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Frequently Asked Questions
What is Suman Setia, M.D.'s specialty? ▼
Suman Setia, M.D. specializes in Adult Medicine Physician and practices in Evergreen Park, Illinois. Credentials: M.D..
How much does Suman Setia, M.D. prescribe under Medicare Part D? ▼
In 2023, Suman Setia, M.D. wrote 8,800 Medicare Part D claims totaling $926K in drug costs for 394 beneficiaries.
What is Suman Setia, M.D.'s Medicare quality score? ▼
Suman Setia, M.D. has a CMS MIPS Final Score of 11.9/100 (Quality: 0, Cost: 39.8). The average MIPS Final Score across the 454,083 clinicians with at least one published category score is 83.5; clinicians whose score CMS assigned without scoring any category are excluded from that average. Source: CMS Merit-based Incentive Payment System (MIPS) 2023.
Where is Suman Setia, M.D. located? ▼
Suman Setia, M.D. is located at 3900 W 95TH ST, Evergreen Park, IL, 60805. Phone: (708) 423-3242.
What is Suman Setia, M.D.'s NPI number? ▼
Suman Setia, M.D.'s National Provider Identifier (NPI) is 1871560169, issued on 03/05/2006.
Does Suman Setia, M.D. prescribe more brand-name or generic drugs? ▼
Suman Setia, M.D.'s prescribing is 12% brand-name and 86% generic drugs by claim count, with $744K in brand drug costs.
Does Suman Setia, M.D. prescribe opioids? ▼
Yes, Suman Setia, M.D. had 237 opioid claims in 2023 with an opioid prescribing rate of 2.7%.
How many Adult Medicine Physician providers are there in the US? ▼
There are 2,481 Adult Medicine Physician providers across 52 states in the US. The average Adult Medicine Physician provider writes 2,807 Medicare Part D claims per year.
What drugs does Suman Setia, M.D. prescribe most often? ▼
Based on 2023 Medicare Part D data, Suman Setia, M.D.'s most frequently prescribed drugs include Atorvastatin Calcium, Amlodipine Besylate, Lisinopril. This reflects Medicare Part D prescriptions only and does not include commercial insurance or other payer types.
Does Suman Setia, M.D. accept Medicare? ▼
Suman Setia, M.D. appears in CMS Medicare data with 8,800 Part D claims and 394 Medicare beneficiaries in 2023. Contact the provider's office directly to confirm current Medicare enrollment and accepted plans.
How can I verify Suman Setia, M.D.'s credentials? ▼
Suman Setia, M.D.'s NPI is 1871560169 with credentials M.D.. 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
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.