SIZAN B PATEL M.D.
NPI 1043655368
Internal Medicine in Toms River, NJ

Q: What is Sizan Patel's NPI number?

The NPI number for Sizan Patel is 1043655368. It was assigned to this individual provider in the NPPES registry on April 30, 2013.

Q: What is Sizan Patel's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Q: When was this NPI record last updated?

The NPPES record for Sizan Patel was last updated on October 11, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 30, 2013PECOS EnrolledAccepts Medicare Assignment

9 HOSPITAL DR STE B1, TOMS RIVER, NJ 08755(732) 363-7200(866) 662-4129 Get Directions Write a Review

NPPES record last updated: October 11, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Oct 11, 2023, Sep 8, 2023, Aug 30, 2023 and 1 more (4 updates tracked since 2022).

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About Sizan B Patel M.d. NPPES

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

SIZAN B PATEL M.D. (NPI 1043655368) is an individual internal medicine provider in Toms River, New Jersey, licensed in New Jersey (25MA09802300) and active in the NPI registry since April 2013. He is enrolled in Medicare PECOS, is affiliated with Community Medical Center, and is a graduate of Other (2008).

NPPES Registry Identity

NPI1043655368

Entity TypeIndividualMale

Primary Taxonomy207R00000X

Provider Legal NameSIZAN B PATELCredential: M.D.

Location Address9 HOSPITAL DR STE B1Toms River, NJ 08755-6425

Mailing Address9 Hospital Dr Ste B1Toms River, NJ 08755-6425 · (732) 363-7200 · Fax (732) 367-4461

Phone(732) 363-7200

Fax(866) 662-4129

Sole ProprietorNo

Medical School CMSOtherGraduated 2008

Enumeration DateApril 30, 2013

Last NPPES UpdateOctober 11, 20234 updates tracked since enumeration

NPPES CertifiedOctober 11, 2023

✔ NPI 1043655368 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

License✔ Licensed in NJ · 25MA09802300

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

9 HOSPITAL DR STE B1, Toms River, NJ 08755

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Other Identifiers 2

Medicaid2797003NJ

Medicaid0524280NJ

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, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Sizan B Patel M.d. 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 ID7618268707

PECOS Enrollment IDI20160621000883

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.

Medicare Billing Reassignments

Medicare enrollment records show Sizan Patel reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Shore Medical Specialists

Same address

Internal Medicine

9 HOSPITAL DR STE B1
Toms River, NJ 08755

Reassigned Medicare billing, New Jersey enrollment
8 clinicians in this Medicare group

NPI 1134217417 (732) 363-7200

Shoremedical5 LLC

Same address

Internal Medicine

9 HOSPITAL DR STE B1
Toms River, NJ 08755

Reassigned Medicare billing, New Jersey enrollment
8 clinicians in this Medicare group

NPI 1962981944 (732) 363-7200

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 9

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.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233

Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.

926 services289 patients

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

288 services88 patients

Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223

Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.

231 services196 patients

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.

98 services54 patients

Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more 99308

A follow-up nursing facility visit per day is a daily check-up service provided by healthcare professionals. It lasts around 15 minutes and involves assessing your health status, monitoring your recovery progress, and addressing any concerns you may have about your health or treatment.

90 services54 patients

Initial nursing facility care with high level of medical decision making, per day, if using time, 50 minutes or more 99306

An initial nursing facility visit is your first meeting with your healthcare team at a nursing facility. Lasting typically 45 minutes, this appointment involves a comprehensive health assessment and the creation of your personalized care plan. It's a crucial step to ensure your health and well-being.

54 services52 patients

Hospital Affiliations CMS Care Compare 2

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

Monmouth Medical Center-Southern Campus

Acute Care Hospitals · Lakewood, NJ

1/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number310084

Location600 River AveLakewood, NJ 08701 · Ocean County

Emergency services

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

$140.34 typical visit price

range $61.59 – $185.05

Typical copayment $35.08 (range $15.39 – $46.26)

Most-billed visit code 99204

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.

71%529 patients3/55-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.

3%331 patients1/55-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…

37%331 patients2/55-star benchmark: 100%

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.

Other Providers at the Same Location NPPES 7

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

SHORE MEDICAL SPECIALISTS

Internal Medicine