SANJIV P PATEL MD
NPI 1144293036
Internal Medicine - Sleep Medicine in Fairfield, OH

Medicare Participation & PECOS Enrollment Status

Sanjiv Patel is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Sanjiv Patel is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

• Is the provider registered in PECOS? Yes

• PECOS PAC ID: 5890773048

  What is the PECOS Associate Control ID?
  A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

• PECOS Enrollment ID: I20040713000728

  What is the Provider Enrollment ID?
  The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

• Accepts Medicare Assignment? Yes

  What does it mean "accepts medicare assignment"?
  When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
  A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

• Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

• Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

• Eligible to Order or Refer a Home Health Agency (HHA): Yes

• Eligible to Order or Refer Power Mobility Devices: Yes

Provider Referred Orders for Durable Medical Equipment, Devices & Supplies

The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.

Durable Medical Equipment

• DME-Other DME (DE001N)

  Tubing with integrated heating element for use with positive airway pressure device (HCPCS:A4604)

  24 DME suppliers used 735 Medicare Claims 735 Services Paid

• DME-Other DME (DE001N)

  Full face mask used with positive airway pressure device, each (HCPCS:A7030)

  21 DME suppliers used 438 Medicare Claims 438 Services Paid

• DME-Other DME (DE001N)

  Face mask interface, replacement for full face mask, each (HCPCS:A7031)

  20 DME suppliers used 388 Medicare Claims 955 Services Paid

• DME-Other DME (DE001N)

  Cushion for use on nasal mask interface, replacement only, each (HCPCS:A7032)

  18 DME suppliers used 257 Medicare Claims 1346 Services Paid

• DME-Other DME (DE001N)

  Pillow for use on nasal cannula type interface, replacement only, pair (HCPCS:A7033)

  17 DME suppliers used 195 Medicare Claims 1057 Services Paid

• DME-Other DME (DE001N)

  Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap (HCPCS:A7034)

  20 DME suppliers used 474 Medicare Claims 474 Services Paid

• DME-Other DME (DE001N)

  Headgear used with positive airway pressure device (HCPCS:A7035)

  27 DME suppliers used 531 Medicare Claims 531 Services Paid

• DME-Other DME (DE001N)

  Chinstrap used with positive airway pressure device (HCPCS:A7036)

  9 DME suppliers used 42 Medicare Claims 42 Services Paid

• DME-Other DME (DE001N)

  Tubing used with positive airway pressure device (HCPCS:A7037)

  13 DME suppliers used 89 Medicare Claims 89 Services Paid

• DME-Other DME (DE001N)

  Filter, disposable, used with positive airway pressure device (HCPCS:A7038)

  28 DME suppliers used 890 Medicare Claims 4739 Services Paid

• DME-Other DME (DE001N)

  Filter, non disposable, used with positive airway pressure device (HCPCS:A7039)

  17 DME suppliers used 287 Medicare Claims 287 Services Paid

• DME-Other DME (DE001N)

  Water chamber for humidifier, used with positive airway pressure device, replacement, each (HCPCS:A7046)

  25 DME suppliers used 356 Medicare Claims 356 Services Paid

• DME-Other DME (DE001N)

  Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) (HCPCS:E0470)

  11 DME suppliers used 823 Medicare Claims 825 Services Paid

• DME-Other DME (DE001N)

  Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) (HCPCS:E0471)

  5 DME suppliers used 65 Medicare Claims 65 Services Paid

• DME-Other DME (DE001N)

  Humidifier, heated, used with positive airway pressure device (HCPCS:E0562)

  9 DME suppliers used 81 Medicare Claims 81 Services Paid

• DME-Other DME (DE001N)

  Humidifier, heated, used with positive airway pressure device (HCPCS:E0562)

  7 DME suppliers used 107 Medicare Claims 114 Services Paid

• DME-Other DME (DE001N)

  Continuous positive airway pressure (cpap) device (HCPCS:E0601)

  13 DME suppliers used 467 Medicare Claims 472 Services Paid

Unknown

• Treatment-Treatment - Miscellaneous (RX029N)

  Mycophenolic acid, oral, 180 mg (HCPCS:J7518)

  1 DME suppliers used 11 Medicare Claims 572 Services Paid

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Established patient office or other outpatient visit, 30-39 minutes

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.

This service was performed 359 times for 273 patients

New patient office or other outpatient visit, 45-59 minutes

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.

This service was performed 97 times for 97 patients

Sleep study in sleep lab (6 years or older)

A sleep study in a sleep lab is a non-invasive overnight test that monitors your body while you sleep. It helps doctors understand your sleep patterns and identify any issues like sleep apnea or insomnia. You'll be connected to equipment that tracks your heart rate, brain waves, breathing, and movements.

This service was performed 70 times for 68 patients

Sleep study in sleep lab with continuous airway pressure (6 years or older)

A sleep study in a sleep lab with continuous airway pressure is a test for individuals aged 6 and above. It monitors your sleep patterns to check for disorders like sleep apnea. Continuous airway pressure helps keep your airways open while you sleep, improving your breathing.

This service was performed 99 times for 96 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $31.53 for a new patient copayment and $24.11 for an established patient copayment.

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 45014 ZIP code area.

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Sanjiv Patel is affiliated with the following medical facilities:

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NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

The NPI number 1144293036 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location

The following 8 providers are registered at the same or nearby location.

Frequently Asked Questions