DR. SWETA SHAH
NPI 1003203118
Family Medicine in Toms River, NJ

Q: What is Sweta Shah's NPI number?

The NPI number for Sweta Shah is 1003203118. It was assigned to this individual provider in the NPPES registry on April 16, 2015.

Q: What is Sweta Shah's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Sweta Shah was last updated on April 8, 2019. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since April 16, 2015PECOS EnrolledAccepts Medicare Assignment

25 MULE RD UNIT B4, TOMS RIVER, NJ 08755(732) 341-0020(732) 341-0072 Get Directions Write a Review

NPPES record last updated: April 8, 2019. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Apr 8, 2019, Nov 10, 2017 (2 updates tracked since 2017).

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About Dr. Sweta Shah NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SWETA SHAH (NPI 1003203118) is an individual family medicine provider in Toms River, New Jersey, licensed in New Jersey (25MB09976600) and active in the NPI registry since April 2015. She is enrolled in Medicare PECOS, is affiliated with Community Medical Center, and is a graduate of Rowan University School Of Osteopathic Medicine (2014).

NPPES Registry Identity

NPI1003203118

Entity TypeIndividualFemale

Primary Taxonomy207Q00000X

Provider Legal NameDR. SWETA SHAH

Location Address25 MULE RD UNIT B4Toms River, NJ 08755-5037

Mailing Address25 Mule Rd Unit B4Toms River, NJ 08755-5037 · (732) 341-0020 · Fax (732) 341-0072

Phone(732) 341-0020

Fax(732) 341-0072

Sole ProprietorYes

Medical School CMSRowan University School Of Osteopathic MedicineGraduated 2014

Enumeration DateApril 16, 2015

Last NPPES UpdateApril 8, 20192 updates tracked since enumeration

✔ NPI 1003203118 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in NJ · 25MB09976600

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

25 MULE RD UNIT B4, Toms River, NJ 08755

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Sweta Shah is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3274800701

PECOS Enrollment IDI20170605000061

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 18

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

642 services353 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

623 services245 patients

Annual depression screening, 5 to 15 minutes G0444

An annual depression screening is a short, routine evaluation to check for signs of depression. It involves answering a series of questions about your feelings, thoughts, and behaviors. The process takes about 15 minutes and helps detect depression early for better management.

342 services342 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

289 services289 patients

Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes G0446

This is a yearly, personal consultation focused on behaviors affecting heart health. It lasts 15 minutes and may cover topics like diet, exercise, and stress management. It's about learning healthy habits to protect your heart.

246 services246 patients

Administration of influenza virus vaccine G0008

The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.

133 services132 patients

Face-to-face behavioral counseling for obesity, 15 minutes G0447

This is a 15-minute consultation where a healthcare professional discusses your eating habits, physical activity, and goals to help manage your weight. The aim is to provide personalized strategies to promote a healthier lifestyle and combat obesity.

71 services66 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

65 services65 patients

Advance care planning, first 30 minutes 99497

Advance care planning is a process where you discuss your healthcare preferences with your doctor. This conversation, lasting up to 30 minutes, helps ensure your wishes are respected if you're unable to communicate them in the future. It's about your care, your way.

57 services57 patients

Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report 93000

An electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.

46 services44 patients

Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit G0438

An annual wellness visit is a yearly appointment with your doctor to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's an opportunity to discuss your health status and goals and get a plan tailored for you.

38 services38 patients

Insertion of needle into vein for collection of blood sample 36415

This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.

32 services28 patients

Urinalysis, manual test 81002

A urinalysis is a simple, non-invasive test that checks the urine for various elements such as sugar, protein, and signs of infection. It can help detect many common conditions, including kidney disease and diabetes. The manual test involves a lab technician examining a urine sample.

29 services20 patients

Smoking and tobacco use intensive counseling, more than 10 minutes 99407

This service involves an in-depth discussion about the risks of smoking and tobacco use, spanning over 10 minutes. It provides personalized strategies to quit smoking, including coping techniques for withdrawal symptoms and triggers. The goal is to support your journey towards a healthier lifestyle.

27 services25 patients

Transitional care management services for problem of high complexity 99496

Transitional care management services are designed to ensure a smooth transition from a hospital to home or another care setting for patients with complex health issues. These services include medication management, patient education, and coordination with healthcare providers.

23 services21 patients

Osteopathic manipulative treatment, 1-2 body regions 98925

Osteopathic Manipulative Treatment (OMT) is a hands-on method where doctors use their hands to diagnose and treat illnesses. For 1-2 body regions, the doctor focuses on specific areas like your back or neck, using techniques to alleviate pain, restore function, and promote healing.

18 services16 patients

Transitional care management services for problem of at least moderate complexity 99495

Transitional care management services focus on coordinating and managing your care after you leave the hospital. For moderate complexity problems, this involves managing your medications, arranging further treatments, and ensuring you have the necessary follow-ups.

15 services15 patients

Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment G0402

An Initial Preventive Physical Examination, also known as a "Welcome to Medicare" visit, is a one-time, face-to-face visit during your first 12 months of Medicare enrollment. It includes a review of your health, as well as education and counseling about preventive services and further screenings.

11 services11 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Community Medical Center

Acute Care Hospitals · Toms River, NJ

1/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number310041

Location99 Rt 37 WestToms River, NJ 08755 · Ocean County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 08755 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$94.90 typical visit price

range $61.59 – $185.05

Typical copayment $23.72 (range $15.39 – $46.26)

Most-billed visit code 99203

Established Patient

$107.94 typical visit price

range $20.08 – $150.98

Typical copayment $26.98 (range $5.02 – $37.74)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

Reported Quality Measures

e-Prescribing

At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.

61%1,408 patients2/55-star benchmark: 100%

Medication Reconciliation

The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.

15%735 patients1/55-star benchmark: 100%

Patient-Specific Education

The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.

97%449 patients4/55-star benchmark: 99%

Provide Patient Access

At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…

31%449 patients2/55-star benchmark: 100%

Secure Messaging

For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…

2%449 patients1/55-star benchmark: 59%

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253

DME-Other DME · category DE017N

7 suppliers13 claims34 services$6.06 avg. paid by Medicare

Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each A7507

DME-Orthotic Devices · category DF000N

1 supplier12 claims552 services$2.33 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DHANVANTI B SHAH MD

Family Medicine

25 MULE RD UNIT B4
TOMS RIVER, NJ 08755

Ocean County (732) 341-0020

MRS. AMY VALANZOLA RDN

Dietitian, Registered

25 MULE RD UNIT B4
TOMS RIVER, NJ 08755

Ocean County (732) 341-0020

BANKIM D SHAH MD

Internal Medicine

25 MULE RD UNIT B4
TOMS RIVER, NJ 08755

Ocean County (732) 341-0020

BANKIM D. SHAH M.D. PA

Internal Medicine

25 MULE RD UNIT B4
TOMS RIVER, NJ 08755

Ocean County (732) 341-0020

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sweta Shah's NPI number?

The NPI number for Sweta Shah is 1003203118. It was assigned to this individual provider in the NPPES registry on April 16, 2015.

Where is Sweta Shah located?

Sweta Shah practices at 25 Mule Rd Unit B4, Toms River, NJ 08755. The listed phone number is (732) 341-0020.

What is Sweta Shah's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Sweta Shah enrolled in Medicare?

Yes. Sweta Shah is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Sweta Shah accept?

Health plans from Ambetter Health and Ambetter Health of Delaware list Sweta Shah as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Sweta Shah affiliated with any hospitals?

According to CMS data, Sweta Shah is affiliated with Community Medical Center.

When was this NPI record last updated?

The NPPES record for Sweta Shah was last updated on April 8, 2019. NPI Profile syncs with the weekly NPPES data releases published by CMS.