DR. VIVEK SUNNY SAMBHARA M.D.
NPI 1093005852
Internal Medicine - Pulmonary Disease in Gainesville, GA

Q: What is Vivek Sambhara's NPI number?

The NPI number for Vivek Sambhara is 1093005852. It was assigned to this individual provider in the NPPES registry on April 13, 2011.

Q: What is Vivek Sambhara's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Pulmonary Disease, with taxonomy code 207RP1001X.

Q: When was this NPI record last updated?

The NPPES record for Vivek Sambhara was last updated on January 6, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months 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 13, 2011PECOS EnrolledAccepts Medicare Assignment

82.77/100

CMS Quality Rating

1240 JESSE JEWELL PKWY SE STE 500, GAINESVILLE, GA 30501(770) 536-9864(770) 297-5023 Get Directions Write a Review

NPPES record last updated: January 6, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 6, 2025, May 19, 2020, May 12, 2020 and 3 more (6 updates tracked since 2017).

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About Dr. Vivek Sunny Sambhara M.d. NPPES

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

DR. VIVEK SUNNY SAMBHARA M.D. (NPI 1093005852) is an individual pulmonary disease provider in Gainesville, Georgia, licensed in Alabama (36045) and active in the NPI registry since April 2011. He is enrolled in Medicare PECOS, is affiliated with Northside Hospital Forsyth, and is a graduate of Morehouse School Of Medicine (2011).

NPPES Registry Identity

NPI1093005852

Entity TypeIndividualMale

Primary Taxonomy207RP1001X

Provider Legal NameDR. VIVEK SUNNY SAMBHARACredential: M.D.

Location Address1240 JESSE JEWELL PKWY SE STE 500Gainesville, GA 30501-3861

Mailing Address1240 Jesse Jewell Pkwy Se Ste 500Gainesville, GA 30501-3861 · (770) 536-9864 · Fax (770) 297-5023

Phone(770) 536-9864

Fax(770) 297-5023

Sole ProprietorYes

Medical School CMSMorehouse School Of MedicineGraduated 2011

Enumeration DateApril 13, 2011

Last NPPES UpdateJanuary 6, 20256 updates tracked since enumeration

NPPES CertifiedJanuary 6, 2025

✔ NPI 1093005852 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyInternal Medicine · Pulmonary DiseaseAllopathic & Osteopathic Physicians

Taxonomy Code207RP1001X

License✔ Licensed in AL · 36045

Definition

An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.

Also ListedInternal MedicineTaxonomy 207R00000X · License 36045 (AL)

Also ListedInternal Medicine · Critical Care MedicineTaxonomy 207RC0200X · License 36045 (AL)

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

1240 JESSE JEWELL PKWY SE STE 500, Gainesville, GA 30501

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Other Identifiers 1

Other102I299613AL · Medicare

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.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. Vivek Sunny Sambhara 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 ID6608008941

PECOS Enrollment IDI20200601001873

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 20

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.

657 services331 patients

Evaluation of use of breathing device 94664

The evaluation of a breathing device involves checking how effectively you're using it to manage your respiratory condition. It assesses the device's fit, your comfort, and your technique to ensure optimal results.

449 services215 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.

249 services194 patients

Blood test, comprehensive group of blood chemicals 80053

A comprehensive group of blood chemicals test, also known as a comprehensive metabolic panel, is a blood test that measures your sugar level, electrolyte and fluid balance, kidney function, and liver function. This helps to check your body's overall health.

229 services187 patients

Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count 85025

A Complete Blood Cell Count is a common test that measures various components of the blood, including red cells (carry oxygen), white cells (fight infection), and platelets (help blood clot). An automated test ensures accuracy. The differential count provides detailed information about white cell types.

223 services188 patients

Test to determine lung volumes using sensors 94726

This test, called spirometry, measures lung capacity using sensors. You breathe into a mouthpiece attached to a device that records the amount and rate of air you inhale and exhale. It helps diagnose and monitor lung conditions.

168 services153 patients

Test to examine how well the lungs exchange gases 94729

This is a test called a pulmonary function test, which helps understand the efficiency of your lungs. It measures how much air your lungs can hold, how quickly you can move air in and out of your lungs, and how well your lungs put oxygen into and remove carbon dioxide from your blood.

168 services153 patients

Test to measure expiratory airflow and volume changes before and after medication administration 94060

This procedure measures how air flows in and out of your lungs. It's done before and after medication to see if the treatment improves your breathing. It's a simple, non-invasive test that involves breathing into a device called a spirometer.

167 services152 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.

143 services142 patients

Ct scan of chest without contrast 71250

A CT scan of the chest without contrast is a non-invasive imaging procedure. It uses special X-ray equipment to produce detailed images of your chest area, including your lungs and heart. It can help diagnose conditions such as lung diseases or heart disorders. It doesn't involve any dyes or contrast agents.

128 services119 patients

New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205

This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.

128 services128 patients

Injection of drug or substance under skin or into muscle 96372

This procedure involves administering medication directly under the skin or into a muscle. A small needle is used to inject the drug, allowing it to be absorbed quickly into the bloodstream. It's a common method for delivering a variety of medications.

56 services25 patients

Smoking and tobacco use intensive counseling, 4-10 minutes 99406

This service provides brief, intensive counseling (4-10 minutes) to support you in quitting smoking or tobacco use. It involves discussing the risks of tobacco use, benefits of quitting, and strategies to help you stop. It's a critical step towards a healthier lifestyle.

46 services32 patients

Measurement c-reactive protein for detection of infection or inflammation 86140

C-reactive protein (CRP) test is a blood test that checks for signs of inflammation or infection in the body. High levels of CRP often suggest that there's inflammation or a bacterial infection. This test helps in monitoring and managing conditions like arthritis and heart disease.

42 services42 patients

X-ray of chest, 2 views 71046

A chest X-ray, 2 views, is a quick, painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. Two different angles are used to get a comprehensive view. This helps in diagnosing conditions like pneumonia, heart problems, or lung cancer.

34 services28 patients

Red blood cell sedimentation rate, to detect inflammation, non-automated 85651

The Red Blood Cell Sedimentation Rate test measures how quickly red blood cells settle at the bottom of a test tube. If they settle faster than normal, it may indicate inflammation in the body. This test is non-automated, meaning it's manually performed by a lab technician.

31 services31 patients

Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making) G0296

This visit involves discussing the necessity of a lung cancer screening using a low dose CT scan. It's a chance to determine if you're eligible for the test and to make an informed decision about proceeding. The scan can potentially detect lung cancer early, improving treatment outcomes.

27 services24 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.

26 services24 patients

Low dose ct scan of chest for lung cancer screening 71271

A low-dose CT scan of the chest is a quick, painless procedure that uses a small amount of radiation to create detailed images of your lungs. It's a key tool for early detection of lung cancer, especially for those at high risk.

22 services22 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

17 services17 patients

Hospital Affiliations CMS Care Compare 3

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

Northside Hospital Forsyth

Acute Care Hospitals · Cumming, GA

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number110005

Location1200 Northside Forsyth DriveCumming, GA 30041 · Forsyth County

Birthing friendly

Northeast Georgia Medical Center, Inc

Acute Care Hospitals · Gainesville, GA

3/5 CMS rating

OwnershipGovernment - Local

CMS Certification Number110029

Location743 Spring StreetGainesville, GA 30501 · Hall County

Emergency services Birthing friendly

Northside Hospital

Acute Care Hospitals · Atlanta, GA

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number110161

Location1000 Johnson Ferry Road, NEAtlanta, GA 30342 · Fulton County

Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30501 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

$124.10 typical visit price

range $53.31 – $164.04

Typical copayment $31.02 (range $13.32 – $41.01)

Most-billed visit code 99204

Established Patient

$94.84 typical visit price

range $16.68 – $133.24

Typical copayment $23.71 (range $4.17 – $33.31)

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.

82.77/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

69.98

Promoting Interoperability

Improvement Activities

Cost

77.6

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.

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431

DME-Oxygen and Supplies · category DC000N

7 suppliers236 claims236 services$17.60 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 supplier35 claims35 services$918.81 avg. paid by Medicare

High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each E0483

DME-Other DME · category DE000N

1 supplier17 claims17 services$805.86 avg. paid by Medicare

Nebulizer, with compressor E0570

DME-Other DME · category DE000N

5 suppliers26 claims30 services$4.45 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

7 suppliers428 claims428 services$93.32 avg. paid by Medicare

Portable oxygen concentrator, rental E1392

DME-Oxygen and Supplies · category DC002N

5 suppliers130 claims130 services$34.35 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 13

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

SHELLEY CHARMAINE MARTIN CNP

Nurse Practitioner