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SINISA IVELJA M.D.
NPI 1205070471
Pathology - Anatomic Pathology & Clinical Pathology in Edison, NJ

Active since April 30, 2009PECOS EnrolledAccepts Medicare Assignment
84.47/100
CMS Quality Rating
122 JAMES ST, EDISON, NJ 08820(732) 243-9694 Get Directions Write a Review

NPPES record last updated: September 18, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Sinisa Ivelja M.d. NPPES

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

SINISA IVELJA M.D. (NPI 1205070471) is an individual anatomic pathology & clinical pathology provider in Edison, New Jersey, licensed in New Jersey (25MA09241200) and active in the NPI registry since April 2009. He is enrolled in Medicare PECOS, is affiliated with Nyu Langone Hospitals, and maintains a secondary practice location in Perth Amboy.

NPPES Registry Identity

NPI1205070471
Entity TypeIndividualMale
Primary Taxonomy207ZP0102X
Provider Legal NameSINISA IVELJACredential: M.D.
Location Address122 JAMES STEdison, NJ 08820-3945
Mailing Address331 Newman Springs Rd Ste 220Red Bank, NJ 07701-5792 · (732) 807-0877
Phone(732) 243-9694
Sole ProprietorNo
Medical School CMSOtherGraduated 1998
Enumeration DateApril 30, 2009
Last NPPES UpdateSeptember 18, 2024
NPPES CertifiedSeptember 18, 2024
✔ NPI 1205070471 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPathology · Anatomic Pathology & Clinical PathologyAllopathic & Osteopathic Physicians
Taxonomy Code207ZP0102X
License✔ Licensed in NJ · 25MA09241200
Definition
A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.
Also ListedPathology · HematologyTaxonomy 207ZH0000X · License 25MA09241200 (NJ)
122 JAMES ST, Edison, NJ 08820
Open in Google Maps ↗

Secondary Practice Location 1

Location 1530 New Brunswick AvePerth Amboy, NJ 08861-3654 · Phone (732) 324-5162

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include 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

Sinisa Ivelja 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 ID941521355
PECOS Enrollment IDI20150610000354, I20201211001759
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 Sinisa Ivelja reassigns Medicare billing to 5 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

East Brunswick Endoscopy Center Inc
7.8 mi
Gastroenterology
385 HIGHWAY 18
East Brunswick, NJ 08816
  • Reassigned Medicare billing, New Jersey enrollment
NPI 1144779133 (908) 347-7766
Kailash Singhvi MD PC
7.8 mi
Gastroenterology
385 HIGHWAY 18 WEST FERRIS PLAZA, UNIT K
East Brunswick, NJ 08816
  • Reassigned Medicare billing, New Jersey enrollment
  • 2 clinicians in this Medicare group
NPI 1538435490 (732) 238-4343
Nj Gastro, LLC
16 mi
Gastroenterology
24 MERCHANT ST
Newark, NJ 07105
  • Reassigned Medicare billing, New Jersey enrollment
  • 10 clinicians in this Medicare group
NPI 1851525661 (972) 645-0000
Hackensack Meridian Health Medical Group - Specialty Care PC
21 mi
Surgical Critical Care
331 NEWMAN SPRINGS RD STE 220
Red Bank, NJ 07701
  • Reassigned Medicare billing, New Jersey enrollment
  • 2,844 clinicians in this Medicare group
NPI 1215989249 (732) 807-0800
New York University
23 mi
Orthopaedic Surgery
303 2ND AVE, SUITE 21
New York, NY 10003
  • Reassigned Medicare billing, New Jersey and New York enrollments
  • Also billed through NPI 1285826438 (New York)
  • 66 clinicians in this Medicare group
NPI 1124078373 (212) 598-6573

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.

Pathology examination of tissue using a microscope, intermediate complexity 88305
A pathology examination of tissue with intermediate complexity involves studying a small sample of your body tissue under a microscope. This helps in identifying any abnormal cells or signs of disease. It's a detailed process requiring expert analysis to ensure accurate results.
1,512 services415 patients
Pathology examination of tissue using a microscope, intermediate complexity 88305
A pathology examination of tissue with intermediate complexity involves studying a small sample of your body tissue under a microscope. This helps in identifying any abnormal cells or signs of disease. It's a detailed process requiring expert analysis to ensure accurate results.
1,163 services318 patients
Special stained specimen slides to examine tissue, initial procedure 88342
This procedure involves the use of specially stained slides to examine tissue samples. The initial process involves obtaining a small tissue sample from your body. This sample is then placed on a slide and stained with special dyes to highlight different structures and elements. The stained slide is then examined under a microscope to help diagnose any potential health issues.
319 services119 patients
Special stained specimen slides to examine tissue, each additional procedure 88341
Special stained specimen slides are used to analyze tissue in detail. In this process, extra procedures may be needed for a more thorough examination. These involve applying special stains to the tissue on slides, enhancing specific elements for closer study.
300 services65 patients
Special stained specimen slides to examine tissue including interpretation and report 88313
Special stained specimen slides are used to examine tissue samples. This involves applying special dyes to the tissue, which helps to highlight certain features under a microscope. The findings are then interpreted and a report is provided. This can aid in diagnosing various health conditions.
276 services82 patients
Special stained specimen slides to examine tissue, initial procedure 88342
This procedure involves the use of specially stained slides to examine tissue samples. The initial process involves obtaining a small tissue sample from your body. This sample is then placed on a slide and stained with special dyes to highlight different structures and elements. The stained slide is then examined under a microscope to help diagnose any potential health issues.
222 services128 patients

Hospital Affiliations CMS Care Compare

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

Nyu Langone Hospitals

Acute Care Hospitals · New York, NY
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number330214
Location550 First AvenueNew York, NY 10016 · New York County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 08820 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.

84.47/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality93.33
Promoting Interoperability100
Improvement Activities40
Cost54.91

Other Providers at the Same Location NPPES 2

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

BHUMI KAMLESH PATEL PHYSICIAN ASSISTANT
Physician Assistant
122 JAMES ST
EDISON, NJ 08820
Middlesex County (732) 243-9694
PULMONARY CRITICAL CARE AND SLEEP ASSOCIATES OF SOMERSET
Internal Medicine (Critical Care Medicine)
122 JAMES ST
EDISON, NJ 08820
Middlesex County (551) 775-1820

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 Sinisa Ivelja's NPI number?

The NPI number for Sinisa Ivelja is 1205070471. It was assigned to this individual provider in the NPPES registry on April 30, 2009.

Where is Sinisa Ivelja located?

Sinisa Ivelja practices at 122 James St, Edison, NJ 08820. The listed phone number is (732) 243-9694.

What is Sinisa Ivelja's specialty?

The primary specialty registered for this NPI is Pathology, specializing in Anatomic Pathology & Clinical Pathology, with taxonomy code 207ZP0102X.

Is Sinisa Ivelja enrolled in Medicare?

Yes. Sinisa Ivelja 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 Sinisa Ivelja's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Sinisa Ivelja reassigns Medicare benefits to 5 organizations: East Brunswick Endoscopy Center Inc (East Brunswick, NJ), Kailash Singhvi MD PC (East Brunswick, NJ), Nj Gastro, LLC (Newark, NJ), Hackensack Meridian Health Medical Group - Specialty Care PC (Red Bank, NJ) and New York University (New York, NY). 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 Sinisa Ivelja's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Sinisa Ivelja accept?

Health plans from Oscar Health list Sinisa Ivelja 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 Sinisa Ivelja affiliated with any hospitals?

According to CMS data, Sinisa Ivelja is affiliated with Nyu Langone Hospitals.

When was this NPI record last updated?

The NPPES record for Sinisa Ivelja was last updated on September 18, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.