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Lionel P Nelson, MD

Otolaryngology · San Jose

NPI 1902838063

Medicare standing
Clear
Enrolled, allowed to bill and order, not excluded
Plans that list them
34
9 carriers
Offices
3

Offices

3 locations · Bass Medical Group · 292 clinicians in this group

Looking this up.

Plans that list them

34 plans · 9 carriers

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

34 of 34 plans

Plans whose provider directory lists this clinician
Advantage Care (HMO)Align Senior CareListedOct 1, 2026
Premier Care (HMO I-SNP)Align Senior CareListedOct 1, 2026
Senior Care (HMO I-SNP)Align Senior CareListedOct 1, 2026
Alignment Health Advantage PPO (PPO)Alignment Health PlanListedOct 3, 2026
Alignment Health BreathEasy (HMO C-SNP)Alignment Health PlanListedOct 3, 2026
Alignment Health Clarity (HMO C-SNP)Alignment Health PlanListedOct 3, 2026
Alignment Health Harmony (HMO)Alignment Health PlanListedOct 3, 2026
Alignment Health Heart & Diabetes (HMO C-SNP)Alignment Health PlanListedOct 3, 2026
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP)Alignment Health PlanListedOct 3, 2026
Alignment Health Heart & Diabetes Care (HMO C-SNP)Alignment Health PlanListedSep 28, 2026
Alignment Health Heart & Diabetes Choice (HMO C-SNP)Alignment Health PlanListedSep 28, 2026
Alignment Health Honor+ Plan (HMO)Alignment Health PlanListedOct 3, 2026
Alignment Health My Choice CalCare (HMO)Alignment Health PlanListedOct 3, 2026
Alignment Health Silicon (HMO C-SNP)Alignment Health PlanListedOct 3, 2026
Alignment Health smartHMO (HMO)Alignment Health PlanListedOct 3, 2026
Alignment Health the ONE (HMO)Alignment Health PlanListedOct 3, 2026
Anthem Medicare Advantage (HMO-POS)Anthem Blue CrossListedOct 3, 2026
Anthem Prime (HMO-POS)Anthem Blue Cross Partnership PlanListedOct 3, 2026
Astiva Health C-SNP WOW - NorCal (HMO C-SNP)Astiva HealthListedSep 27, 2026
Astiva Health Premier Plan - NorCal (HMO)Astiva HealthListedSep 27, 2026
Astiva Health Savings Plan - NorCal (HMO)Astiva HealthListedSep 27, 2026
Blue Shield Inspire (HMO)Blue Shield of CaliforniaListedAug 26, 2026
Central Health Classic Care Plan III (HMO)Central Health Medicare PlanListedAug 15, 2026
Central Health Dual Access Plan (HMO D-SNP)Central Health Medicare PlanListedAug 15, 2026
Central Health Embrace Care Plan (HMO C-SNP)Central Health Medicare PlanListed, may be out of dateSep 15, 2025
Central Health Embrace Choice Plan (HMO C-SNP)Central Health Medicare PlanListedAug 15, 2026
Central Health Valor Care Plan (HMO)Central Health Medicare PlanListedAug 15, 2026
Imperial Courage Plan (HMO)Imperial Health Plan of California, Inc.ListedSep 1, 2026
Imperial Dynamic Plan (HMO)Imperial Health Plan of California, Inc.ListedSep 1, 2026
Imperial Senior Value (HMO C-SNP)Imperial Health Plan of California, Inc.ListedSep 1, 2026
SCAN Balance (HMO C-SNP)SCAN Health PlanListedOct 3, 2026
SCAN Classic (HMO)SCAN Health PlanListedOct 3, 2026
SCAN MyChoice (HMO)SCAN Health PlanListedOct 3, 2026
SCAN Strive (HMO C-SNP)SCAN Health PlanListedOct 3, 2026

California Medical Board record

Licence G19842 · Current

Licensed to practise in California · since 1971 · expires 2028-02-29 · Yale University School of Medicine.

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

Surgery centers they own

  • Silicon Valley Surgery Center, LPAmbulatory Surgery Center · Campbell, CA1.27% owner since 2012 · accredited by AAAHC
    Accreditation Renewed4 inspections, 1 with deficiencies · last 2024-09-16
  • Silicon Valley Surgery Center, LP - BascomAmbulatory Surgery Center · Campbell, CA1.27% owner since 2012 · accredited by AAAHC
    Accreditation RenewedNo inspections published

Original Medicare doctor bills

$81,001

Medicare paid this office $81,001 for 335 people.

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

Largest Original Medicare bills
Return visit (30+ min)122$18,388$113
Short return visit (20+ min)117$12,105$80
Long return visit (40+ min)57$9,822$166
Diagnostic exam of voice box using a flexible endoscope65$8,956$128
New patient visit (30+ min)90$8,444$94
See all 7 services
Every Original Medicare service billed
Return visit (30+ min)122$18,388$113
Short return visit (20+ min)117$12,105$80
Long return visit (40+ min)57$9,822$166
Diagnostic exam of voice box using a flexible endoscope65$8,956$128
New patient visit (30+ min)90$8,444$94
New patient visit (45+ min)51$6,814$134
Diagnostic exam of nasal passages using an endoscope35$6,812$184

Who their Medicare patients are

335 Original Medicare patients in 2024. Average age 77 · Women 59% · Also on Medicaid 4% · Health risk score 0.97. At or below the middle of the specialty; the typical otolaryngology clinician is at 1.19.

Conditions among them: High blood pressure 71% · Coronary heart disease 31% · Diabetes 25% · Atrial fibrillation 20% · Chronic kidney disease 19% · Cancer 17% · Depression 15% · Heart failure 13% · Stroke 12% · COPD 10% · Dementia 4%.

The office billed $315,751, Medicare allowed $110,178 and paid $81,001; for 675 services of 22 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
2024335675770.97$315,751$81,001
2023386769771.04$339,188$89,864
2022417894781.02$403,478$105,215
2021334750781.03$343,707$96,250
2020178323761.14$137,820$32,286
20195321,316771.13$507,922$138,685
20185711,448761.13$529,153$138,071
20175751,494771.06$586,138$149,694
20166281,305771.13$324,817$136,903
20156181,213761.12$386,000$144,510
20146221,231761.01$396,020$144,669
2013511992751.08$270,030$113,932

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: 9 services

Original Medicare services billed in 2023
Return visit (30+ min)141$22,496$116
Short return visit (20+ min)141$13,616$79
Diagnostic exam of nasal passages using an endoscope51$11,694$195
New patient visit (30+ min)101$9,965$99
New patient visit (45+ min)72$9,947$138
Long return visit (40+ min)44$7,214$157
Diagnostic exam of voice box using a flexible endoscope43$6,355$130
Simple control of nose bleed11$2,620$175
Short return visit21$1,210$48

2022: 10 services

Original Medicare services billed in 2022
Return visit (30+ min)170$27,107$113
Diagnostic exam of nasal passages using an endoscope55$15,129$192
Short return visit (20+ min)145$13,841$77
New patient visit (30+ min)116$10,616$92
New patient visit (45+ min)75$10,389$139
Diagnostic exam of voice box using a flexible endoscope61$8,459$128
Long return visit (40+ min)47$7,824$160
Simple control of nose bleed30$5,237$145
New patient visit (60+ min)12$2,507$209
Short return visit12$608$51

2021: 9 services

Original Medicare services billed in 2021
Return visit (30+ min)131$23,372$124
Short return visit (20+ min)135$14,901$86
Diagnostic exam of nasal passages using an endoscope55$14,840$206
New patient visit (45+ min)75$11,377$152
Diagnostic exam of voice box using a flexible endoscope55$8,253$131
New patient visit (30+ min)80$8,230$103
Simple control of nose bleed14$2,926$163
Long return visit (40+ min)15$2,527$168
Short return visit18$1,125$56

2020: 6 services

Original Medicare services billed in 2020
Return visit (30+ min)88$10,006$87
Diagnostic exam of nasal passages using an endoscope25$5,151$178
New patient visit (30+ min)41$3,374$82
Short return visit (20+ min)47$2,693$52
New patient visit (45+ min)18$2,269$126
Diagnostic exam of voice box using a flexible endoscope20$2,182$109

2019: 12 services

Original Medicare services billed in 2019
Return visit (30+ min)210$32,184$101
Diagnostic exam of nasal passages using an endoscope104$26,918$198
Short return visit (20+ min)222$20,794$67
New patient visit (30+ min)178$17,071$96
New patient visit (45+ min)89$12,506$141
Diagnostic exam of voice box using a flexible endoscope76$9,453$107
Simple control of nose bleed28$4,568$134
Removal of impacted ear wax42$1,925$44
Long return visit (40+ min)13$1,662$128
New patient visit (15+ min)20$1,257$63
Exam of ear using a microscope18$458$25
Short return visit11$445$40

2018: 11 services

Original Medicare services billed in 2018
Return visit (30+ min)245$32,202$94
Diagnostic exam of nasal passages using an endoscope95$22,971$198
Short return visit (20+ min)200$16,908$63
New patient visit (30+ min)177$15,736$89
New patient visit (45+ min)104$14,278$137
Diagnostic exam of voice box using a flexible endoscope121$13,385$99
Simple control of nose bleed33$4,855$116
Exam of ear using a microscope126$4,545$28
Long return visit (40+ min)17$1,831$108
New patient visit (15+ min)18$983$55
Repositioning exercises of head for treatment of dizziness, each day11$429$39

2017: 11 services

Original Medicare services billed in 2017
Return visit (30+ min)274$36,567$94
Diagnostic exam of nasal passages using an endoscope94$21,824$191
New patient visit (45+ min)150$19,867$132
Diagnostic exam of voice box using a flexible endoscope122$13,665$100
New patient visit (30+ min)154$13,216$86
Short return visit (20+ min)145$10,908$59
Exam of ear using a microscope139$4,992$28
Long return visit (40+ min)36$4,727$124
Simple control of nose bleed20$1,749$76
New patient visit (15+ min)14$759$54
Short return visit11$409$34

2016: 11 services

Original Medicare services billed in 2016
Return visit (30+ min)214$27,837$93
New patient visit (45+ min)181$25,155$139
Diagnostic exam of nasal passages using an endoscope74$19,771$208
Diagnostic exam of voice box using a flexible endoscope123$14,898$109
Short return visit (20+ min)185$13,928$64
New patient visit (30+ min)136$12,163$89
Simple control of nose bleed26$3,073$83
Exam of ear using a microscope70$2,577$30
Long return visit (40+ min)13$1,827$130
Short return visit20$814$41
New patient visit (15+ min)11$756$69

2015: 9 services

Original Medicare services billed in 2015
Return visit (30+ min)225$30,624$95
New patient visit (45+ min)186$27,064$146
Diagnostic exam of nasal passages using an endoscope65$18,608$209
New patient visit (30+ min)143$13,213$92
Diagnostic exam of voice box using a flexible endoscope106$12,941$110
Short return visit (20+ min)147$11,869$62
Simple control of nose bleed31$3,398$89
New patient visit (15+ min)18$1,120$62
Short return visit13$466$36

2014: 11 services

Original Medicare services billed in 2014
Return visit (30+ min)186$22,475$95
New patient visit (45+ min)150$21,833$146
New patient visit (30+ min)184$16,792$91
Diagnostic exam of nasal passages using an endoscope54$14,004$212
Diagnostic exam of voice box using a flexible endoscope119$13,729$110
Short return visit (20+ min)168$12,533$62
Simple control of nose bleed30$3,497$90
Long return visit (40+ min)25$2,940$113
Removal of impacted ear wax45$2,238$42
New patient visit (15+ min)33$2,167$66
Short return visit12$540$42

2013: 11 services

Original Medicare services billed in 2013
Return visit (30+ min)164$19,318$95
New patient visit (45+ min)113$16,330$145
Diagnostic exam of voice box using a flexible endoscope93$11,622$114
Short return visit (20+ min)141$11,029$64
New patient visit (30+ min)110$10,151$92
Diagnostic exam of nasal passages using an endoscope24$7,472$220
Long return visit (40+ min)35$5,342$119
Simple control of nose bleed26$2,590$86
New patient visit (15+ min)37$2,212$60
Short return visit34$1,303$34
Removal of impacted ear wax14$748$50

Drugs they prescribed that Part D paid

$6,941

Pharmacies billed $6,941 in 2024.

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

Opioids were 0% of their Part D prescriptions (0 of 274) in 2024. At or below the middle of the specialty; the typical otolaryngology clinician is at 4%.

268 generic and fewer than 11 brand-name prescriptions · $6,941 in drug cost · 22 antibiotic prescriptions to 16 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
Ipratropium71$1,974$28
Pilocarpine19$990$52
Fluocinolone Acetonide Oil17$520$31
Mometasone Furoate24$172$7
Montelukast16$157$10
See all 7 drugs
Every Part D drug this clinician prescribed
Ipratropium71$1,974$28
Pilocarpine19$990$52
Fluocinolone Acetonide Oil17$520$31
Mometasone Furoate24$172$7
Montelukast16$157$10
Methylprednisolone22$141$6
Mupirocin11$44$4

Year by year

Part D prescribing by year
20242741300% (0)None$6,941
20232201010% (0)None$6,502
20222251170% (0)None$7,857
2021197930% (0)None$5,434
2020167690% (0)None$4,474
20193651790% (0)3%$10,417
2018308145NoneNone$10,535
20173511634% (13)None$9,419
20164321853% (14)None$9,395
20154881903% (13)5%$10,901
20144811914% (18)7%$12,277
20134461665% (21)13%$18,888

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

See the drugs prescribed each year

2023: 7 drugs

Part D drugs prescribed in 2023
Ipratropium47$1,494$32
Azelastine12$914$76
Fluocinolone Acetonide Oil15$751$50
Montelukast22$535$24
Methylprednisolone30$347$12
Mometasone Furoate16$263$16
Amoxicillin-Clavulanate Potass12$192$16

2022: 6 drugs

Part D drugs prescribed in 2022
Ipratropium60$2,563$43
Fluocinolone Acetonide Oil11$907$82
Amoxicillin-Clavulanate Potass16$239$15
Mometasone Furoate18$199$11
Methylprednisolone18$190$11
Clotrimazole-Betamethasone12$121$10

2021: 5 drugs

Part D drugs prescribed in 2021
Ipratropium65$2,508$39
Mometasone Furoate22$278$13
Montelukast12$181$15
Amoxicillin-Clavulanate Potass14$176$13
Methylprednisolone18$137$8

2020: 4 drugs

Part D drugs prescribed in 2020
Ipratropium49$2,211$45
Montelukast28$410$15
Omeprazole15$201$13
Methylprednisolone13$134$10

2019: 8 drugs

Part D drugs prescribed in 2019
Ipratropium65$3,331$51
Neomycin-Polymyxin-Hc13$787$61
Montelukast43$631$15
Amoxicillin-Clavulanate Potass32$413$13
Methylprednisolone43$408$9
Mometasone Furoate22$367$17
Omeprazole26$361$14
Prednisone24$109$5

2018: 8 drugs

Part D drugs prescribed in 2018
Ipratropium61$3,072$50
Montelukast27$428$16
Azelastine13$428$33
Methylprednisolone28$337$12
Amoxicillin-Clavulanate Potass22$284$13
Mometasone Furoate19$281$15
Omeprazole19$232$12
Prednisone19$81$4

2017: 9 drugs

Part D drugs prescribed in 2017
Ipratropium50$1,919$38
Neomycin-Polymyxin-Hc22$1,147$52
Fluticasone Propionate26$556$21
Amoxicillin-Clavulanate Potass33$496$15
Methylprednisolone29$397$14
Montelukast24$323$13
Mometasone Furoate19$175$9
Prednisone31$152$5
Hydrocodone-Acetaminophen13$83$6

2016: 11 drugs

Part D drugs prescribed in 2016
Ipratropium44$1,087$25
Fluticasone Propionate87$958$11
Amoxicillin-Clavulanate Potass43$642$15
Neomycin-Polymyxin-Hc13$623$48
Methylprednisolone42$599$14
Cephalexin20$417$21
Mometasone Furoate27$315$12
Montelukast18$244$14
Omeprazole12$226$19
Hydrocodone-Acetaminophen13$121$9
Prednisone25$98$4

2015: 12 drugs

Part D drugs prescribed in 2015
Fluticasone Propionate127$1,399$11
Montelukast34$1,319$39
Ipratropium38$869$23
Methylprednisolone41$739$18
Neomycin-Polymyxin-Hc22$451$20
Amoxicillin-Clavulanate Potass32$434$14
Levofloxacin20$391$20
Omeprazole20$209$10
Hydrocodone-Acetaminophen11$121$11
Mometasone Furoate14$86$6
Prednisone15$81$5
Cephalexin13$70$5

2014: 10 drugs

Part D drugs prescribed in 2014
Fluticasone Propionate149$2,270$15
Montelukast38$1,823$48
Ipratropium30$706$24
Azelastine11$590$54
Amox Tr-Potassium Clavulanate30$581$19
Methylprednisolone29$579$20
Hydrocodone-Acetaminophen17$230$14
Prednisone27$139$5
Mometasone Furoate11$114$10
Cephalexin15$93$6

2013: 11 drugs

Part D drugs prescribed in 2013
Fluticasone Propionate159$4,317$27
Montelukast23$2,431$106
Nasonex12$1,932$161
Triamcinolone Acetonide13$667$51
Azelastine11$643$58
Amox Tr-Potassium Clavulanate24$527$22
Ipratropium14$433$31
Methylprednisolone15$346$23
Neomycin-Polymyxin-Hc14$295$21
Hydrocodone-Acetaminophen19$193$10
Prednisone16$53$3

Money from drug and device companies

$201 in 2024

Industry payments by year
202411None$201
201922None$55

Paid work is consulting, speaking, honoraria and royalties, as opposed to meals and travel.

A payment is not proof that care is biased.

Payments by company
Neurent MedicalNeuromark Device$201
1 payment
  • Meals for Neuromark Device · 2024-03-22 · $201
See the published payment
Every published payment
Neurent MedicalMeals · 2024-03-22Neuromark Device$201
See earlier years (2019)

2019: $55

Payments by company in 2019
Smith+NephewCoblation Wands$44
1 payment
  • Meals for Coblation Wands · 2019-04-24 · $44
Philips Electronics North AmericaPremium Gum Care$12
1 payment
  • Meals for Premium Gum Care · 2019-06-17 · $12

Checkups this office reported

17 measures · 2023

Medicare asked this office to report how often certain checkups happened in 2023. This is not a grade for the doctor. A specialist’s patients may not need every screening.

Medicare’s overall office score
87.3 / 100
Scores the office’s reporting and systems. It is not a grade for how the doctor treats you.
Checkup rates this office reported to Medicare
Appropriate Treatment for Upper Respiratory Infection (URI)As Medicare defines this measure96%46
Asked about smokingPatients asked about tobacco, with help to quit if they smoke88%That's most of the people this applied to.460
Blood pressure under controlPeople with high blood pressure whose reading was in a healthy range41%That's less than half.111
Bone-density scans that were not neededYounger women who got a bone scan without a medical reason0%That's few of the people this applied to. Better on this measure.103
Breast cancer screeningEligible women who got a mammogram24%That's few of the people this applied to.303
Cervical cancer screeningEligible women who got a Pap or HPV test16%That's few of the people this applied to.340
Checked for fall riskOlder patients screened for fall risk4%That's few of the people this applied to.543
Colon cancer screeningEligible adults who got a colon cancer test13%That's few of the people this applied to.643
See the other 9 measures
More measures this office reported to Medicare
Depression screeningPatients screened for depression, with a follow-up plan if needed2%That's few of the people this applied to.1,215
Diabetes eye examPeople with diabetes who got a retinal eye exam14%That's few of the people this applied to.29
Diabetes poorly controlledPeople with diabetes whose blood sugar stayed very high66%That's more than half. Worse on this measure.29
HIV screeningEligible patients who were screened for HIV12%That's few of the people this applied to.749
Medications listed in the chartVisits where the current medication list was documented97%That's most of the people this applied to.1,936
Patients can see their records onlinePatients who were given electronic access to their health information97%That's most of the people this applied to.344
Prescriptions sent electronicallyPrescriptions sent to the pharmacy by computer instead of paper98%That's most of the people this applied to.150
Statin prescribed when it protects the heartPeople at cardiovascular risk who were prescribed a statin75%That's most of the people this applied to.129
Weight checked, with a follow-up planPatients whose BMI was recorded and followed up if needed45%That's less than half.1,240

What the office says it does

Boxes the office ticked on its Medicare worksheet for 2023. Nobody checks these.

  • Agreed to federal review of their records system
  • Did a security review of patient data
  • Exchanges records both ways with other health systems
  • Improved the patient portal
  • Lets patients read their visit notes
  • Shows lab and imaging costs when ordering tests
  • Uses standard treatment protocols
  • Exempt from electronic case reporting
  • Exempt from immunization registry reporting
  • Exempt from query of the prescription drug monitoring program (pdmp)

Professional record

NPI
1902838063
Licence
CA G19842California G19842: Current · expires 2028-02-29
Trained
Yale University School of Medicine, 1969
Gender
Male
More record details
Sole proprietor
No
Medicaid ID
CA 00G198420
Taxonomy
Otolaryngology (207Y00000X)
Mailing address
2577 Samaritan Dr Ste 765, San Jose, CA, 95124
NPI first listed
2006-07-07
NPI last updated
2025-02-28
NPI record certified
2025-02-28

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

Extra NPI addresses: 2505 Samaritan Dr #510, San Jose, CA, 95124