DR. NIRAJ NIRAULA MD
NPI 1215223722
Internal Medicine - Pulmonary Disease in Youngstown, OH

Q: What is Niraj Niraula's NPI number?

The NPI number for Niraj Niraula is 1215223722. It was assigned to this individual provider in the NPPES registry on June 22, 2011.

Q: What is Niraj Niraula'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 Niraj Niraula was last updated on October 12, 2022. 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.

Active since June 22, 2011PECOS EnrolledAccepts Medicare Assignment

4694 BELMONT AVE, YOUNGSTOWN, OH 44505(330) 480-4080(330) 480-4078 Get Directions Write a Review

NPPES record last updated: October 12, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Oct 12, 2022, Nov 10, 2016 (2 updates tracked since 2016).

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About Dr. Niraj Niraula Md NPPES

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

DR. NIRAJ NIRAULA MD (NPI 1215223722) is an individual pulmonary disease provider in Youngstown, Ohio, licensed in Ohio (35.130116) and active in the NPI registry since June 2011. He is enrolled in Medicare PECOS, is affiliated with St Elizabeth Youngstown Hospital, and is a graduate of Other (2004).

NPPES Registry Identity

NPI1215223722

Entity TypeIndividualMale

Primary Taxonomy207RP1001X

Provider Legal NameDR. NIRAJ NIRAULACredential: MD

Location Address4694 BELMONT AVEYoungstown, OH 44505-1012

Mailing Address4694 Belmont AveYoungstown, OH 44505-1012 · (330) 480-4080 · Fax (330) 480-4078

Phone(330) 480-4080

Fax(330) 480-4078

Sole ProprietorNo

Medical School CMSOtherGraduated 2004

Enumeration DateJune 22, 2011

Last NPPES UpdateOctober 12, 20222 updates tracked since enumeration

NPPES CertifiedOctober 12, 2022

✔ NPI 1215223722 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · Pulmonary DiseaseAllopathic & Osteopathic Physicians

Taxonomy Code207RP1001X

Licenses✔ Licensed in OH · 35.130116✔ Licensed in TN · 51496

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 51496 (TN)

4694 BELMONT AVE, Youngstown, OH 44505

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health 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. Niraj Niraula Md 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 ID648406884

PECOS Enrollment IDI20170403002578

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 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.

Critical care, first 30-74 minutes 99291

Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.

256 services86 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.

159 services74 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.

61 services39 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.

45 services26 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.

38 services38 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.

18 services18 patients

Hospital Affiliations CMS Care Compare 3

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

St Elizabeth Youngstown Hospital

Acute Care Hospitals · Youngstown, OH

2/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number360064

Location1044 Belmont AvenueYoungstown, OH 44501 · Mahoning County

Emergency services

Mh St Joseph Warren Hospital

Acute Care Hospitals · Warren, OH

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number360161

Location667 Eastland Ave SEWarren, OH 44484 · Trumbull County

Emergency services Birthing friendly

Hmhp St Elizabeth Boardman Health Center

Acute Care Hospitals · Boardman, OH

3/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number360276

Location8401 Market StreetBoardman, OH 44512 · Mahoning County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 44505 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

$126.12 typical visit price

range $54.34 – $166.65

Typical copayment $31.53 (range $13.58 – $41.66)

Most-billed visit code 99204

Established Patient

$96.44 typical visit price

range $17.10 – $135.40

Typical copayment $24.11 (range $4.27 – $33.85)

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

Colorectal Cancer Screening

Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer

17%48 patients1/55-star benchmark: 100%

Pneumococcal Vaccination Status for Older Adults

Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine

34%67 patients2/55-star benchmark: 100%

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…

86%81 patients4/55-star benchmark: 100%

Screening for Osteoporosis for Women Aged 65-85 Years of Age

Percentage of female patients aged 65-85 years of age who ever had a central dual-energy X-ray absorptiometry (DXA) to check for osteoporosis

34%38 patients2/55-star benchmark: 98%

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.

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

2 suppliers33 claims33 services$58.05 avg. paid by Medicare

Portable oxygen concentrator, rental E1392

DME-Oxygen and Supplies · category DC002N

3 suppliers34 claims34 services$29.44 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 5

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

SHAWNA KOPRUCKI MD

Family Medicine