Skip to main content
UniHealth

Doctor search

Sushma V Pai, MD

Hospitalist · San Jose

NPI 1619188596

Medicare standing
Clear
Enrolled, allowed to bill and order, not excluded
Plans that list them
1
1 carrier
Offices
2

Offices

2 locations · County of Santa Clara · 1,000 clinicians in this group

Looking this up.

Hospitals listed: Santa Clara Valley Medical Center. That is not proof they admit you there this week.

Plans that list them

1 plan · 1 carrier

A missing listing does not mean out of network. Directories change, and a listing does not cover every office. Call Dr. Pai’s office at (408) 885-5000 to confirm they take your plan. Ask about the office you use, its medical group, referrals and appointments.

Plans whose provider directory lists this clinician
Anthem Full Dual Advantage Aligned (HMO D-SNP)Anthem Blue CrossListedOct 3, 2026

California Medical Board record

Licence A104547 · Current

Licensed to practise in California · since 2008 · expires 2028-01-31 · University of Mumbai, Topiwala National Medical College.

Matched on the licence number without its letter prefix; check the name before relying on it.

No disciplinary actions, convictions, malpractice judgments or citations in this record.

Hospitals they work in

1 hospital

These rate the hospital, not this clinician. Most measures at most hospitals are no different from the national rate.

  • Santa Clara Valley Medical CenterSan Jose, CAAcute Care Hospital · Government - Local · Has an emergency department · Birthing-friendlyPart of Santa Clara Valley Health and Hospital System, which runs 3 hospitalsPatients rate it 3 of 5 · 70% would definitely recommend it
    Overall rating: 2 of 5 starsWorse than the national rate — SSI - Colon Surgery: 2.572, Oct 2024 – Sep 2025Better than the national rate — Central Line Associated Bloodstream Infection (ICU + select Wards): 0.563, Oct 2024 – Sep 2025Better than the national rate — Clostridium Difficile (C.Diff): 0.256, Oct 2024 – Sep 2025Better than the national rate — MRSA Bacteremia: 0.369, Oct 2024 – Sep 2025
See every measure and the patient survey for Santa Clara Valley Medical Center

Behind the star rating — Deaths: 2 better, 6 the same, 0 worse of 8 measures. Safety: 2 better, 5 the same, 1 worse of 8 measures. Readmissions: 0 better, 10 the same, 1 worse of 11 measures. The star rating is worked out from an earlier period than the measures below, so the two can disagree.

Every scored measure at Santa Clara Valley Medical Center
SSI - Colon SurgeryInfections2.572WorseOct 2024 – Sep 2025
Central Line Associated Bloodstream Infection (ICU + select Wards)Infections0.563BetterOct 2024 – Sep 2025
Clostridium Difficile (C.Diff)Infections0.256BetterOct 2024 – Sep 2025
MRSA BacteremiaInfections0.369BetterOct 2024 – Sep 2025
Abdominopelvic accidental puncture or laceration rateComplications and deaths1.25 (0.3 to 2.2) · 1,535 casesNo differentJul 2022 – Jun 2024
CMS Medicare PSI 90: Patient safety and adverse events compositeComplications and deaths1.07 (0.76 to 1.38)No differentJul 2022 – Jun 2024
Death rate among surgical inpatients with serious treatable complicationsComplications and deaths214.59 (167.38 to 261.8) · 108 casesNo differentJul 2022 – Jun 2024
Death rate for CABG surgery patientsComplications and deaths2.8 · 41 casesNoneJul 2022 – Jun 2025
Death rate for COPD patientsComplications and deaths6 · 141 casesNoneJul 2022 – Jun 2025
Death rate for heart attack patientsComplications and deaths10.2 · 124 casesNoneJul 2022 – Jun 2025
Death rate for heart failure patientsComplications and deaths8.3 · 501 casesNoneJul 2022 – Jun 2025
Death rate for pneumonia patientsComplications and deaths14.9 · 653 casesNoneJul 2022 – Jun 2025
Death rate for stroke patientsComplications and deaths10.1 · 348 casesNoneJul 2023 – Jun 2025
Hybrid Hospital-Wide All-Cause Risk Standardized Mortality RateComplications and deaths3 · 4,502 casesNoneJul 2024 – Jun 2025
Iatrogenic pneumothorax rateComplications and deaths0.24 (0.04 to 0.43) · 9,014 casesNo differentJul 2022 – Jun 2024
In-hospital fall-associated fracture rateComplications and deaths0.34 (0.15 to 0.52) · 9,216 casesNo differentJul 2022 – Jun 2024
Perioperative pulmonary embolism or deep vein thrombosis rateComplications and deaths4.54 (2.51 to 6.58) · 1,421 casesNo differentJul 2022 – Jun 2024
Postoperative acute kidney injury requiring dialysis rateComplications and deaths1.54 (0 to 3.2) · 288 casesNo differentJul 2022 – Jun 2024
Postoperative hemorrhage or hematoma rateComplications and deaths2.11 (0.66 to 3.56) · 1,446 casesNo differentJul 2022 – Jun 2024
Postoperative respiratory failure rateComplications and deaths11.61 (4.09 to 19.14) · 294 casesNo differentJul 2022 – Jun 2024
Postoperative sepsis rateComplications and deaths7.29 (3.39 to 11.2) · 299 casesNo differentJul 2022 – Jun 2024
Postoperative wound dehiscence rateComplications and deaths1.9 (0.45 to 3.36) · 333 casesNo differentJul 2022 – Jun 2024
Pressure ulcer rateComplications and deaths0.23 (0 to 0.78) · 7,538 casesNo differentJul 2022 – Jun 2024
Rate of complications for hip/knee replacement patientsComplications and deaths5.4 · 94 casesNoneApr 2023 – Mar 2025
Catheter Associated Urinary Tract Infections (ICU + select Wards)Infections0.735No differentOct 2024 – Sep 2025
SSI - Abdominal HysterectomyInfections2.573No differentOct 2024 – Sep 2025
Acute Myocardial Infarction (AMI) 30-Day Readmission RateUnplanned return visits14.6 · 185 casesNoneJul 2023 – Jun 2025
Heart failure (HF) 30-Day Readmission RateUnplanned return visits22.1 · 951 casesNoneJul 2023 – Jun 2025
Hospital return days for heart attack patientsUnplanned return visits56.3 · 128 casesNoneJul 2022 – Jun 2025
Hospital return days for heart failure patientsUnplanned return visits6.4 · 644 casesNoneJul 2022 – Jun 2025
Hospital return days for pneumonia patientsUnplanned return visits1.3 · 699 casesNoneJul 2022 – Jun 2025
Pneumonia (PN) 30-Day Readmission RateUnplanned return visits16.3 · 921 casesNoneJul 2023 – Jun 2025
Rate of emergency department (ED) visits for patients receiving outpatient chemotherapyUnplanned return visits5.7 (3.9 to 8.1) · 226 casesNo differentJan 2024 – Dec 2024
Rate of inpatient admissions for patients receiving outpatient chemotherapyUnplanned return visits12.6 (9.4 to 16.5) · 226 casesNo differentJan 2024 – Dec 2024
Rate of readmission after hip/knee replacementUnplanned return visits5.4 · 94 casesNoneJul 2023 – Jun 2025
Rate of readmission for CABGUnplanned return visits11.4 · 54 casesNoneJul 2023 – Jun 2025
Rate of readmission for chronic obstructive pulmonary disease (COPD) patientsUnplanned return visits20.3 · 242 casesNoneJul 2023 – Jun 2025
Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)Unplanned return visits13.2 (9.9 to 17.4) · 702 casesNo differentJan 2022 – Dec 2024
Ratio of unplanned hospital visits after hospital outpatient surgeryUnplanned return visits1 (0.7 to 1.4) · 195 casesNo differentJan 2024 – Dec 2024

What patients said (4,032 patients answered, 29% of those asked)

Patient survey stars by topic at Santa Clara Valley Medical Center
Cleanliness3
Nurse communication3
Doctor communication3
Communication about medicines3
Discharge information2
Overall hospital rating3
Quietness2
Recommend hospital4
Share of patients giving the best answer at Santa Clara Valley Medical Center
Room was "always" clean70%
Nurses "always" communicated well73%
Doctors "always" communicated well76%
Staff "always" explained57%
Yes, staff "did" give patients this information82%
Yes, staff "did" give patients information about help after discharge82%
Doctors "always" explained things so they could understand71%
Doctors "always" listened carefully74%
Doctors "always" treated them with courtesy and respect82%
Patients who gave a rating of "9" or "10" (high)67%
Staff "always" explained new medications71%
Nurses "always" explained things so they could understand71%
Nurses "always" listened carefully69%
Nurses "always" treated them with courtesy and respect80%
"Always" quiet at night43%
"YES", patients would definitely recommend the hospital70%
Staff "always" explained possible side effects44%
Yes, staff "did" give patients information about possible symptoms83%

Original Medicare doctor bills

$53,431

Medicare paid this office $53,431 for 219 people.

This is what Medicare paid the clinician — not Medicare Advantage, and not the pharmacy.

Largest Original Medicare bills
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes148$29,069$69
Hospital discharge day management, more than 30 minutes98$10,507$104
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes38$6,401$107
Initial hospital care with moderate level of medical decision making at least 75 minutes22$3,423$156
Initial hospital care with straightforward or low-level medical decision making at least 55 minutes27$2,924$108
See all 6 services
Every Original Medicare service billed
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes148$29,069$69
Hospital discharge day management, more than 30 minutes98$10,507$104
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes38$6,401$107
Initial hospital care with moderate level of medical decision making at least 75 minutes22$3,423$156
Initial hospital care with straightforward or low-level medical decision making at least 55 minutes27$2,924$108
Subsequent hospital care with straightforward or low level of medical decision making, per day at least 25 minutes12$882$40

Who their Medicare patients are

219 Original Medicare patients in 2024. Average age 74 · Under 65 17% · 85 and older 19% · Women 48% · Also on Medicaid 76% · Health risk score 3.63. Sicker patients than 9 in 10 peers; the typical hospitalist clinician is at 2.49.

Conditions among them: High blood pressure 75% · Diabetes 61% · Coronary heart disease 56% · Heart failure 54% · Chronic kidney disease 52% · COPD 38% · Atrial fibrillation 38% · Dementia 37% · Depression 36% · Stroke 21% · Cancer 16%.

The office billed $545,469, Medicare allowed $68,820 and paid $53,431; for 658 services of 8 kinds.

Original Medicare patients only. A risk score of 1.0 is the average Medicare patient; higher means sicker. Any count under 11 is hidden.

Year by year

Original Medicare by year
2024219658743.63$545,469$53,431
2023312752752.69$542,353$67,875
2022323863752.95$681,654$83,549
2021337798732.69$568,643$85,939
2020358964752.55$441,063$98,486
2019358879742.66$449,176$90,056
2018341777742.66$330,643$82,255
2017299355702.94$189,440$49,655
2016213221702.58$114,048$30,920
2015241252712.79$111,234$33,082
2014221227712.42$99,671$27,752
2013230311712.76$106,692$29,919

Original Medicare only. A service billed for fewer than 11 people in a year is hidden, so the lines can add up to less than the year's total.

See the services billed each year

2023: 5 services

Original Medicare services billed in 2023
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes210$31,992$73
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes87$14,325$113
Hospital discharge day management, more than 30 minutes94$9,955$106
Initial hospital care with moderate level of medical decision making at least 75 minutes47$7,330$156
Initial hospital care with straightforward or low-level medical decision making at least 55 minutes25$3,099$119

2022: 5 services

Original Medicare services billed in 2022
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes199$43,650$96
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes98$13,130$71
Hospital discharge day management, more than 30 minutes98$10,762$104
Initial hospital care with moderate level of medical decision making at least 75 minutes46$9,182$200
Subsequent hospital care with straightforward or low level of medical decision making, per day at least 25 minutes18$1,116$43

2021: 5 services

Original Medicare services billed in 2021
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes192$41,681$103
Initial hospital care with moderate level of medical decision making at least 75 minutes66$13,423$203
Hospital discharge day management, more than 30 minutes111$12,828$111
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes82$9,922$73
Hospital observation care on day of discharge24$1,868$78

2020: 8 services

Original Medicare services billed in 2020
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes212$53,526$101
Hospital discharge day management, more than 30 minutes128$13,878$107
Initial hospital care with moderate level of medical decision making at least 75 minutes58$11,322$195
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes57$6,926$71
Subsequent nursing facility care with straightforward level of medical decision making, per day 20 minutes or more42$4,060$67
Initial nursing facility care with high level of medical decision making, per day 50 minutes or more12$1,905$159
Subsequent nursing facility care with moderate level of medical decision making, per day at least 30 minutes18$1,584$88
Advance care planning, first 30 minutes16$1,345$79

2019: 8 services

Original Medicare services billed in 2019
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes162$33,884$93
Initial hospital care with moderate level of medical decision making at least 75 minutes119$21,564$178
Hospital discharge day management, more than 30 minutes117$11,692$97
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes100$10,508$65
Initial hospital observation care per day, typically 70 minutes40$6,591$165
Advance care planning, first 30 minutes20$1,496$71
Hospital observation care on day of discharge17$1,135$67
Initial hospital care with straightforward or low level of medical decision making, per day at least 40 minutes12$1,085$90

2018: 7 services

Original Medicare services billed in 2018
Initial hospital care with moderate level of medical decision making at least 75 minutes136$24,593$181
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes119$23,962$94
Hospital discharge day management, more than 30 minutes106$10,566$99
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes97$9,283$65
Initial hospital observation care per day, typically 70 minutes46$7,586$161
Advance care planning, first 30 minutes30$2,142$71
Hospital observation care on day of discharge20$1,337$67

2017: 7 services

Original Medicare services billed in 2017
Initial hospital care with moderate level of medical decision making at least 75 minutes128$23,402$179
Initial hospital observation care per day, typically 70 minutes69$11,620$166
Initial hospital observation care per day, typically 50 minutes37$3,715$100
Initial hospital care with straightforward or low-level medical decision making at least 55 minutes30$3,522$117
Subsequent hospital care with moderate levelof medical decision making at least 50 minutes18$2,517$93
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes16$1,684$65
Hospital discharge day management, more than 30 minutes13$1,276$98

2016: 4 services

Original Medicare services billed in 2016
Initial hospital care with moderate level of medical decision making at least 75 minutes60$10,916$176
Initial hospital observation care per day, typically 70 minutes42$6,862$163
Initial hospital care with straightforward or low-level medical decision making at least 55 minutes58$6,593$114
Initial hospital observation care per day, typically 50 minutes45$5,184$115

2015: 4 services

Original Medicare services billed in 2015
Initial hospital care with moderate level of medical decision making at least 75 minutes57$9,929$174
Initial hospital care with straightforward or low-level medical decision making at least 55 minutes87$9,741$112
Initial hospital observation care per day, typically 70 minutes38$6,054$159
Initial hospital observation care per day, typically 50 minutes51$5,889$113

2014: 5 services

Original Medicare services billed in 2014
Initial hospital care with straightforward or low-level medical decision making at least 55 minutes75$8,809$114
Initial hospital observation care per day, typically 50 minutes68$7,465$110
Initial hospital care with moderate level of medical decision making at least 75 minutes27$4,826$179
Initial hospital observation care per day, typically 70 minutes26$4,235$163
Initial hospital care with straightforward or low level of medical decision making, per day at least 40 minutes12$887$74

2013: 8 services

Original Medicare services billed in 2013
Initial hospital care with straightforward or low-level medical decision making at least 55 minutes100$11,720$114
Subsequent hospital care with moderate levelof medical decision making at least 35 minutes47$4,389$61
Initial hospital observation care per day, typically 50 minutes24$2,698$112
Initial hospital care with moderate level of medical decision making at least 75 minutes14$2,428$173
Initial hospital observation care per day, typically 70 minutes11$1,621$147
Hospital discharge day management, more than 30 minutes16$1,450$91
Initial hospital care with straightforward or low level of medical decision making, per day at least 40 minutes13$1,078$83
Hospital observation care on day of discharge14$966$64

Medicaid work

$13,026 in 2024

Medicaid paid $13,026 for 1,204 billed services this clinician did in 2024, up to 41 people in a month for one service.

Medicaid and CHIP claims where this clinician did the service, fee-for-service and managed care together. Any month with fewer than 11 patients is hidden, so small Medicaid practices undercount.

Largest Medicaid services in 2024
SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES898$8,316
Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter258$3,946
1ST HOSP IP/OBS HIGH 7514$379
SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES22$233
1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES12$152
Medicaid work by year
20241,204541$13,026
20231,293441$15,939
20221,117329$21,851
2021870436$15,434
2020699225$14,001
2019557423$15,629
2018487430$15,761
See the largest Medicaid services in earlier years

2023

Largest Medicaid services in 2023
SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES856$9,533
Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter239$4,036
SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES183$2,137
1ST HOSP IP/OBS HIGH 7515$232

2022

Largest Medicaid services in 2022
SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES630$12,249
SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES291$5,871
Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter196$3,731

2021

Largest Medicaid services in 2021
SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES593$10,328
Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter134$2,711
SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES131$2,017
1ST HOSP IP/OBS HIGH 7512$377

2020

Largest Medicaid services in 2020
SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES639$12,727
Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter60$1,274

2019

Largest Medicaid services in 2019
1ST HOSP IP/OBS HIGH 75160$6,557
SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES293$6,375
Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter61$1,869
SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES43$828

2018

Largest Medicaid services in 2018
SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES257$7,327
1ST HOSP IP/OBS HIGH 75115$4,959
Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter97$3,066
SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES18$408

Drugs they prescribed that Part D paid

$11,918

Pharmacies billed $11,918 in 2024.

This is pharmacy cost, not the office bill, and not what patients paid.

Opioids were 6% of their Part D prescriptions (13 of 218) in 2024. Above the middle of the specialty; the typical hospitalist clinician is at 4%.

191 generic and fewer than 11 brand-name prescriptions · $11,918 in drug cost · 43 antibiotic prescriptions to 28 people.

Part D prescriptions only. The opioid rate is opioid prescriptions as a share of all this clinician's Part D prescriptions; surgeons and pain specialists run higher than others, so it is shown against the same specialty.

Largest Part D drug costs
Meropenem13$1,786$137
Pantoprazole16$86$5

Year by year

Part D prescribing by year
2024218846% (13)None$11,918
202321492NoneNone$14,050
2022223937% (15)20%$14,992
2021183916% (11)None$11,851
2020190898% (15)21%$15,397
201913276None16%$10,151
2018174828% (14)15%$8,212
201716110% (0)0%$127
201616None0% (0)None$1,074
201450None0% (0)None$3,692
20139330None18%$5,181

Part D prescriptions only. A drug prescribed to fewer than 11 people in a year is hidden.

See the drugs prescribed each year

2023: 1 drug

Part D drugs prescribed in 2023
Furosemide13$40$3

2022: 3 drugs

Part D drugs prescribed in 2022
Eliquis13$7,166$551
Albuterol Sulfate Hfa11$509$46
Furosemide12$47$4

2020: 5 drugs

Part D drugs prescribed in 2020
Eliquis17$7,485$440
Amoxicillin-Clavulanate Potass11$82$7
Pantoprazole11$70$6
Hydrocodone-Acetaminophen11$56$5
Prednisone11$39$4

2019: 1 drug

Part D drugs prescribed in 2019
Pantoprazole11$99$9

2018: 3 drugs

Part D drugs prescribed in 2018
Atorvastatin14$141$10
Hydrocodone-Acetaminophen12$100$8
Prednisone11$40$4

Money from drug and device companies

$85 in 2025

A payment is not proof that care is biased.

Payments by company
Abbott LaboratoriesFreestyle Libre 3$85
1 payment
  • Meals for Freestyle Libre 3 · 2025-10-02 · $85
See the published payment
Every published payment
Abbott LaboratoriesMeals · 2025-10-02Freestyle Libre 3$85

Checkups this office reported

Medicare did not publish checkup rates for this clinician.

Medicare’s overall office score
80.6 / 100
Scores the office’s reporting and systems. It is not a grade for how the doctor treats you.

Professional record

NPI
1619188596
Licence
CA 104547California A104547: Current · expires 2028-01-31
Gender
Female
More record details
Sole proprietor
Yes
Taxonomy
Hospitalist (208M00000X); Internal medicine (207R00000X)
Mailing address
751 S Bascom Ave, San Jose, CA, 95128
NPI first listed
2007-05-24
NPI last updated
2018-03-17

This is when the NPI record was last certified, not a medical board exam.

Extra NPI addresses: 225 N Jackson Ave, San Jose, CA, 95116