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DR. THEODORE P SGAMBATI M.D.
NPI 1053398602
Internal Medicine in Paramus, NJ

Active since December 26, 2005PECOS Enrolled
98.67/100
CMS Quality Rating
2 SEARS DR, FLOOR 2, PARAMUS, NJ 07652(201) 262-2333(201) 262-4515 Get Directions Write a Review

NPPES record last updated: March 17, 2014. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Theodore P Sgambati M.d. NPPES

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

DR. THEODORE P SGAMBATI M.D. (NPI 1053398602) is an individual internal medicine provider in Paramus, New Jersey, licensed in New Jersey (MA055600) and active in the NPI registry since December 2005. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1053398602
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameDR. THEODORE P SGAMBATICredential: M.D.
Location Address2 SEARS DR, FLOOR 2Paramus, NJ 07652-3539
Mailing Address33 Highland RdMontvale, NJ 07645-2013 · (201) 476-0929
Phone(201) 262-2333
Fax(201) 262-4515
Sole ProprietorNo
Enumeration DateDecember 26, 2005
Last NPPES UpdateMarch 17, 2014
✔ NPI 1053398602 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 · MA055600
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.
2 SEARS DR, Paramus, NJ 07652
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Other Identifiers 3

Medicaid5370906NJ
Medicare UPINE58227NJ
Medicare ID-Type Unspecified629228NJ

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Theodore P Sgambati M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Reassignment

Medicare enrollment records show Theodore Sgambati reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Valley Physician Services PC
1.6 mi
Internal Medicine
15 ESSEX RD
Paramus, NJ 07652
  • Reassigned Medicare billing, New Jersey enrollment
  • 833 clinicians in this Medicare group
NPI 1467815928 (201) 291-6086

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 14

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 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.
293 services65 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.
260 services211 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.
224 services187 patients
Residence visit for established patient with straightforward medical decision making, per day, if using time, at least 15 minutes 99347
An established patient home visit is a service where a healthcare professional visits your home for a 15-minute check-up. It's designed for patients who have previously seen the professional. The visit may include basic health assessments and discussions about your ongoing care.
206 services57 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.
122 services112 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.
116 services116 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 07652 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
$144.86 typical visit price
range $63.84 – $190.92
Typical copayment $36.21 (range $15.96 – $47.73)
Most-billed visit code 99204
Established Patient
$111.57 typical visit price
range $20.97 – $155.92
Typical copayment $27.89 (range $5.24 – $38.98)
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.

98.67/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality93.57
Promoting Interoperability100
Improvement Activities40

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.
96%6,042 patients4/55-star benchmark: 99%
Health Information Exchange
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for…
75%186 patients4/55-star benchmark: 88%
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.
98%86 patients4/55-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.
72%1,696 patients3/55-star benchmark: 97%
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…
97%1,696 patients4/55-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…
29%1,696 patients2/55-star benchmark: 89%
View, Download, or Transmit (VDT)
At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period.
41%1,696 patients
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 8

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
22 suppliers68 claims156 services$5.60 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
18 suppliers42 claims48 services$1.09 avg. paid by Medicare
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress E0260
DME-Hospital Beds · category DB000N
3 suppliers34 claims34 services$43.31 avg. paid by Medicare
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) E0466
DME-Other DME · category DE005N
1 supplier16 claims16 services$909.16 avg. paid by Medicare
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
DME-Oxygen and Supplies · category DC002N
1 supplier18 claims18 services$59.23 avg. paid by Medicare
Portable oxygen concentrator, rental E1392
DME-Oxygen and Supplies · category DC002N
1 supplier14 claims14 services$31.14 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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.

NORTH AMERICAN DIAGNOSTIC IMAGING, LLC
Contractor
2 SEARS DR, 2ND FLOOR
PARAMUS, NJ 07652
Bergen County (800) 865-0500
ONE OAK MEDICAL GROUP, LLC
Specialist
2 SEARS DR
PARAMUS, NJ 07652
Bergen County (973) 870-0777
LONGEVITY MEDICAL GROUP, P.A.
Specialist
2 SEARS DR
PARAMUS, NJ 07652
Bergen County (201) 265-4647
BERGEN MEDICAL IMAGING, LLC
Clinic/Center (Medical Specialty)
2 SEARS DR
PARAMUS, NJ 07652
Bergen County (201) 652-0188

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 Theodore Sgambati's NPI number?

The NPI number for Theodore Sgambati is 1053398602. It was assigned to this individual provider in the NPPES registry on December 26, 2005.

Where is Theodore Sgambati located?

Theodore Sgambati practices at 2 Sears Dr Floor 2, Paramus, NJ 07652. The listed phone number is (201) 262-2333.

What is Theodore Sgambati's specialty?

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

Is Theodore Sgambati enrolled in Medicare?

Yes. Theodore Sgambati is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Theodore Sgambati's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Theodore Sgambati reassigns Medicare benefits to Valley Physician Services PC (Paramus, NJ). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Theodore Sgambati's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Theodore Sgambati was last updated on March 17, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.