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NIKUNJKUMAR PATEL
NPI 1174039309
Internal Medicine - Endocrinology, Diabetes & Metabolism in Toms River, NJ

Active since December 26, 2017PECOS Enrolled
99 RTE 37 W, TOMS RIVER, NJ 08755(732) 781-6428 Get Directions Write a Review

NPPES record last updated: July 7, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 7, 2023, Aug 17, 2020, May 2, 2019 and 1 more (4 updates tracked since 2017).

About Nikunjkumar Patel NPPES

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

NIKUNJKUMAR PATEL (NPI 1174039309) is an individual endocrinology, diabetes & metabolism provider in Toms River, New Jersey, licensed in New Jersey (25MA10366100) and active in the NPI registry since December 2017. He is enrolled in Medicare PECOS, is affiliated with Community Medical Center, and is a graduate of Other (2010).

NPPES Registry Identity

NPI1174039309
Entity TypeIndividualMale
Primary Taxonomy207RE0101X
Provider Legal NameNIKUNJKUMAR PATEL
Location Address99 RTE 37 WToms River, NJ 08755-6423
Mailing Address1925 Pacific AveAtlantic City, NJ 08401-6713 · (609) 441-8146 · Fax (609) 441-8002
Phone(732) 781-6428
Sole ProprietorNo
Medical School CMSOtherGraduated 2010
Enumeration DateDecember 26, 2017
Last NPPES UpdateJuly 7, 20234 updates tracked since enumeration
NPPES CertifiedJuly 7, 2023
✔ NPI 1174039309 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · Endocrinology, Diabetes & MetabolismAllopathic & Osteopathic Physicians
Taxonomy Code207RE0101X
License✔ Licensed in NJ · 25MA10366100
Definition
An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems.
Also ListedInternal MedicineTaxonomy 207R00000X · License 25MA10366100 (NJ)
99 RTE 37 W, 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, Oscar Health.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nikunjkumar Patel is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1355696444
PECOS Enrollment IDI20180613001341
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

5

Medicare enrollment records show Nikunjkumar Patel reassigns Medicare billing to 5 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Atlanticare Physician Group, PA
38 mi
Urgent Care
110 E JIMMIE LEEDS RD
Galloway, NJ 08205
  • Reassigned Medicare billing, New Jersey enrollment
  • 921 clinicians in this Medicare group
NPI 1003820622 (609) 748-2100
Oceans Prime Diabetes And Endocrinology LLC
40 mi
Endocrinology, Diabetes & Metabolism
405 PLAZA DR
Woodbridge, NJ 07095
  • Reassigned Medicare billing, New Jersey enrollment
  • 3 clinicians in this Medicare group
NPI 1730893769 (732) 993-5040
Rwjbh Emergency Medicine Associates, LLC
43 mi
Emergency Medicine
3 EXECUTIVE DR, STE 400
Somerset, NJ 08873
  • Reassigned Medicare billing, New Jersey enrollment
  • 1,557 clinicians in this Medicare group
NPI 1912510041 (732) 867-9618
Barnabas Health Medical Group PC
48 mi
Specialist
225 WILLIAMSON ST
Elizabeth, NJ 07202
  • Reassigned Medicare billing, New Jersey enrollment
  • 1,894 clinicians in this Medicare group
NPI 1841557246 (888) 724-7123
Rwjbh Observation Associates LLC
55 mi
Emergency Medicine
94 OLD SHORT HILLS RD
Livingston, NJ 07039
  • Reassigned Medicare billing, New Jersey enrollment
  • 1,913 clinicians in this Medicare group
NPI 1760095806 (888) 724-7123

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 10

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 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.
4,394 services715 patients
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
1,026 services844 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.
768 services353 patients
Continuous monitoring of blood sugar level in tissue fluid using sensor under skin with interpretation and report 95251
This procedure involves placing a small sensor under your skin to continuously monitor your blood sugar levels in tissue fluid. The data is interpreted and a report is generated to help manage your diabetes more effectively.
200 services95 patients
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203
This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
124 services124 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.
85 services85 patients

Hospital Affiliations CMS Care Compare 5

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

Ocean Medical Center

Acute Care Hospitals · Brick, NJ
3/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number310052
Location425 Jack Martin BlvdBrick, NJ 08724 · Ocean County
Emergency services Birthing friendly

Monmouth Medical Center

Acute Care Hospitals · Long Branch, NJ
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number310075
Location300 Second AvenueLong Branch, NJ 07740 · Monmouth County
Emergency services Birthing friendly

Jfk Medical Center

Acute Care Hospitals · Edison, NJ
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number310108
Location65 James StreetEdison, NJ 08820 · Middlesex County
Emergency services Birthing friendly

Southern Ocean Medical Center

Acute Care Hospitals · Manahawkin, NJ
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number310113
Location1140 Rt 72 WManahawkin, NJ 08050 · 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
$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

Care Plan
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker…
68%125 patients3/55-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 19

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

MR. CHRISTOPHER WASHINGTON CRNA
Nurse Anesthetist, Certified Registered
99 RTE 37 W
TOMS RIVER, NJ 08755
Ocean County (609) 652-1000
DR. MERRITT WEAVER BROWN III M.D.
Psychiatry & Neurology (Neurology)
99 RTE 37 W
TOMS RIVER, NJ 08755
Ocean County (833) 656-3876
LAUREN CAMPISANO PA
Physician Assistant (Medical)
99 RTE 37 W
TOMS RIVER, NJ 08755
Ocean County (732) 557-8000
ABDALMAJEED IYOUN MD
Student in an Organized Health Care Education/Training Program
99 RTE 37 W
TOMS RIVER, NJ 08755
Ocean County (732) 557-2090
NICHOLAS JESUS FLORES DNP, CRNA
Nurse Anesthetist, Certified Registered
99 RTE 37 W
TOMS RIVER, NJ 08755
Ocean County (732) 557-8000
TOMS RIVER INPATIENT SERVICES LLC
Hospitalist
99 RTE 37 W
TOMS RIVER, NJ 08755
Ocean County (973) 251-1132
DR. WILLIAM KENNETH BONNAH BOATENG MD
Internal Medicine
99 RTE 37 W
TOMS RIVER, NJ 08755
Ocean County (732) 557-2061
DR. YASH MISHRA MD
Student in an Organized Health Care Education/Training Program
99 RTE 37 W
TOMS RIVER, NJ 08755
Ocean County (732) 557-8000

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 Nikunjkumar Patel's NPI number?

The NPI number for Nikunjkumar Patel is 1174039309. It was assigned to this individual provider in the NPPES registry on December 26, 2017.

Where is Nikunjkumar Patel located?

Nikunjkumar Patel practices at 99 Rte 37 W, Toms River, NJ 08755. The listed phone number is (732) 781-6428.

What is Nikunjkumar Patel's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Endocrinology, Diabetes & Metabolism, with taxonomy code 207RE0101X.

Is Nikunjkumar Patel enrolled in Medicare?

Yes. Nikunjkumar Patel is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Nikunjkumar Patel's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nikunjkumar Patel reassigns Medicare benefits to 5 organizations: Atlanticare Physician Group, PA (Galloway, NJ), Oceans Prime Diabetes And Endocrinology LLC (Woodbridge, NJ), Rwjbh Emergency Medicine Associates, LLC (Somerset, NJ), Barnabas Health Medical Group PC (Elizabeth, NJ) and Rwjbh Observation Associates LLC (Livingston, NJ). Each 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 Nikunjkumar Patel's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Nikunjkumar Patel accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Oscar Health list Nikunjkumar Patel 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 Nikunjkumar Patel affiliated with any hospitals?

According to CMS data, Nikunjkumar Patel is affiliated with Community Medical Center, Ocean Medical Center, Monmouth Medical Center, Jfk Medical Center and Southern Ocean Medical Center.

When was this NPI record last updated?

The NPPES record for Nikunjkumar Patel was last updated on July 7, 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.