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DR. MAHMOUD EL BANNA M.D.
NPI 1194036483
Internal Medicine in Somerset, NJ

Active since July 01, 2010PECOS EnrolledAccepts Medicare Assignment
1323 STATE ROUTE 27, SOMERSET, NJ 08873(732) 828-0200(732) 828-0300 Get Directions Write a Review

NPPES record last updated: March 11, 2014. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dr. Mahmoud El Banna M.d. NPPES

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

DR. MAHMOUD EL BANNA M.D. (NPI 1194036483) is an individual internal medicine provider in Somerset, New Jersey, licensed in New Jersey (25MA09261400) and active in the NPI registry since July 2010. He is enrolled in Medicare PECOS, is affiliated with Saint Peter's University Hospital, and is a graduate of Other (2010).

NPPES Registry Identity

NPI1194036483
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameDR. MAHMOUD EL BANNACredential: M.D.
Location Address1323 STATE ROUTE 27Somerset, NJ 08873-3457
Mailing Address1323 State Route 27Somerset, NJ 08873-3457 · (732) 828-0200 · Fax (732) 828-0300
Phone(732) 828-0200
Fax(732) 828-0300
Sole ProprietorYes
Medical School CMSOtherGraduated 2010
Enumeration DateJuly 1, 2010
Last NPPES UpdateMarch 11, 2014
✔ NPI 1194036483 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 · 25MA09261400
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.
1323 STATE ROUTE 27, Somerset, NJ 08873
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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 and accepts Medicare assignment

Dr. Mahmoud El Banna 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 ID1850527003
PECOS Enrollment IDI20131119000476
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

2

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

Saint Peter's University Hospital
2.7 mi
General Acute Care Hospital
254 EASTON AVE
New Brunswick, NJ 08901
  • Reassigned Medicare billing, New Jersey enrollment
  • Medicare enrollment name: Saint Peters University Hospital
  • 325 clinicians in this Medicare group
NPI 1114924834 (732) 745-6651
Saint Peter's Healthcare System Physician Associates
2.8 mi
General Practice
254 EASTON AVE
New Brunswick, NJ 08901
  • Reassigned Medicare billing, New Jersey enrollment
  • 105 clinicians in this Medicare group
NPI 1548569361 (732) 745-6651

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 7

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.
356 services212 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.
146 services146 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.
108 services92 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.
32 services32 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.
18 services14 patients
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.
16 services13 patients

Hospital Affiliations CMS Care Compare 2

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

Saint Peter's University Hospital

Acute Care Hospitals · New Brunswick, NJ
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number310070
Location254 Easton AveNew Brunswick, NJ 08901 · Middlesex 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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 08873 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.

Reported Quality Measures

Breast Cancer Screening
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
70%223 patients4/55-star benchmark: 92%
Colorectal Cancer Screening
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
67%498 patients4/55-star benchmark: 85%
Diabetes: Eye Exam
Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period
62%165 patients3/55-star benchmark: 100%
Documentation of Current Medications in the Medical Record
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.
100%2,968 patients5/55-star benchmark: 100%
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.
98%3,835 patients4/55-star benchmark: 99%
Falls: Screening for Future Fall Risk
Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period
35%229 patients2/55-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…
27%517 patients2/55-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.
100%580 patients5/55-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.
91%56 patients4/55-star benchmark: 97%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
89%1,279 patients4/55-star benchmark: 97%
Preventive Care and Screening: Screening for Depression and Follow-Up Plan
Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen
19%1,212 patients1/55-star benchmark: 96%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Patients screenedForUse: 99% · 1,045 patients
Patients tobacco: 15% · 60 patients
93%1,045 patients4/55-star benchmark: 98%
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…
94%1,354 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…
46%1,354 patients3/55-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.
54%1,354 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 2

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
11 suppliers18 claims51 services$6.42 avg. paid by Medicare
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
1 supplier12 claims12 services$185.34 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

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

PLANNED PARENTHOOD OF NORTHERN, CENTRAL, AND SOUTHERN NEW JERSEY, INC.
Clinic/Center (Ambulatory Family Planning Facility)
1323 STATE ROUTE 27, 1ST FLOOR
FRANKLIN TOWNSHIP, NJ 08873
Somerset County (732) 246-2673

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 Mahmoud El Banna's NPI number?

The NPI number for Mahmoud El Banna is 1194036483. It was assigned to this individual provider in the NPPES registry on July 1, 2010.

Where is Mahmoud El Banna located?

Mahmoud El Banna practices at 1323 State Route 27, Somerset, NJ 08873. The listed phone number is (732) 828-0200.

What is Mahmoud El Banna's specialty?

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

Is Mahmoud El Banna enrolled in Medicare?

Yes. Mahmoud El Banna is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Mahmoud El Banna's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mahmoud El Banna reassigns Medicare benefits to 2 organizations: Saint Peter's University Hospital (New Brunswick, NJ) and Saint Peter's Healthcare System Physician Associates (New Brunswick, 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 Mahmoud El Banna's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Mahmoud El Banna accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Oscar Health list Mahmoud El Banna 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 Mahmoud El Banna affiliated with any hospitals?

According to CMS data, Mahmoud El Banna is affiliated with Saint Peter's University Hospital and Jfk Medical Center.

When was this NPI record last updated?

The NPPES record for Mahmoud El Banna was last updated on March 11, 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.