SUNIL PATEL M.D
NPI 1255354726
Internal Medicine - Cardiovascular Disease in Maplewood, NJ

Active since July 25, 2006PECOS EnrolledAccepts Medicare Assignment
100/100
CMS Quality Rating
2010 SPRINGFIELD AVE, MAPLEWOOD, NJ 07040(973) 275-9500(973) 275-9501 Get Directions Write a Review

NPPES record last updated: March 4, 2014. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Sunil Patel M.d NPPES

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

SUNIL PATEL M.D (NPI 1255354726) is an individual cardiovascular disease provider in Maplewood, New Jersey, licensed in New Jersey (MA073729) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS, is affiliated with Newark Beth Israel Medical Center, and is a graduate of Other (1996).

NPPES Registry Identity

NPI1255354726
Entity TypeIndividualMale
Primary Taxonomy207RC0000X
Provider Legal NameSUNIL PATELCredential: M.D
Location Address2010 SPRINGFIELD AVEMaplewood, NJ 07040-3437
Mailing AddressPo Box 178Colonia, NJ 07067-0178 · (973) 275-9500 · Fax (973) 275-9501
Fax(973) 275-9501
Sole ProprietorYes
Medical School CMSOtherGraduated 1996
Enumeration DateJuly 25, 2006
Last NPPES UpdateMarch 4, 2014
NPI 1255354726 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyInternal Medicine · Cardiovascular DiseaseAllopathic & Osteopathic Physicians
Taxonomy Code207RC0000X
License Licensed in NJ · MA073729
Definition
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.
2010 SPRINGFIELD AVE, Maplewood, NJ 07040

Other Identifiers 3

Medicare ID-Type Unspecified070125NJ
Medicare UPINH85408NJ
Medicaid0010332NJ

Accepted 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

Sunil Patel 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 ID3971593393
PECOS Enrollment IDI20040517000580
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 49

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 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.
535 services161 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.
354 services166 patients
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report 93000
An electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.
203 services161 patients
Injection, dipyridamole, per 10 mg J1245
Dipyridamole injection is a medication used to prevent blood clots. It's given in doses of 10 mg, typically through an IV. The medication helps to keep your blood flowing smoothly by preventing platelets from clumping together in your veins.
136 services27 patients
Ultrasound of heart with color-depicted blood flow, rate, direction and valve function 93306
This is a heart ultrasound, also known as an echocardiogram. It uses sound waves to create pictures of your heart, showing how blood flows through it. The color depicts the blood flow's speed and direction. It also checks the heart's valves to ensure they're working properly.
128 services124 patients
Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision and review by physician 93015
An exercise or drug-induced heart stress test with ECG is a procedure performed by a doctor to assess how your heart responds to exertion. It involves monitoring your heart's electrical activity while you exercise or after medication is given to mimic exercise effects.
119 services101 patients

Hospital Affiliations CMS Care Compare

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

Newark Beth Israel Medical Center

Acute Care Hospitals · Newark, NJ
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number310002
Location201 Lyons AveNewark, NJ 07112 · Essex County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 07040 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
$79.09 typical visit price
range $20.97 – $155.92
Typical copayment $19.77 (range $5.24 – $38.98)
Most-billed visit code 99213
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.

100/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Individually scored
Quality100
Improvement Activities40

Reported Quality Measures

Breast Cancer Screening
8%605 patients1/55-star benchmark: 93%
Closing the Referral Loop: Receipt of Specialist Report
0%108 patients1/55-star benchmark: 87%
Colorectal Cancer Screening
13%1,276 patients1/55-star benchmark: 88%
Controlling High Blood Pressure
100%610 patients5/55-star benchmark: 91%
Coronary Artery Disease (CAD): Beta-Blocker Therapy Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <= 40%)
100%34 patients5/55-star benchmark: 99%
Diabetes: Eye Exam
0%395 patients1/55-star benchmark: 100%
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
Lower rates are better for this measure.
100%569 patients1/55-star benchmark: 91%
Documentation of Current Medications in the Medical Record
100%7,452 patients5/55-star benchmark: 100%
Falls: Screening for Future Fall Risk
0%622 patients1/55-star benchmark: 100%
Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
100%62 patients5/55-star benchmark: 100%
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
100%60 patients5/55-star benchmark: 100%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
21%1,876 patients1/55-star benchmark: 98%
Preventive Care and Screening: Screening for Depression and Follow-Up Plan
0%1,880 patients1/55-star benchmark: 97%
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
100%1,272 patients5/55-star benchmark: 61%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Patients combinedPopulations: 100% · 1,979 patients
Patients screened: 100% · 2,003 patients
100%149 patients5/55-star benchmark: 100%
Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
86%967 patients4/55-star benchmark: 91%
Use of High-Risk Medications in Older Adults
Lower rates are better for this measure.
Patients appropriateDiagnosis: 0% · 677 patients
Patients totalRate: 1% · 677 patients
1%677 patients4/55-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.

Referred Medical Equipment & Supplies CMS DME claims 10

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Full face mask used with positive airway pressure device, each A7030
DME-Other DME · category DE001N
3 suppliers14 claims14 services$67.63 avg. paid by Medicare
Face mask interface, replacement for full face mask, each A7031
DME-Other DME · category DE001N
3 suppliers13 claims33 services$22.89 avg. paid by Medicare
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034
DME-Other DME · category DE001N
3 suppliers12 claims12 services$38.86 avg. paid by Medicare
Headgear used with positive airway pressure device A7035
DME-Other DME · category DE001N
4 suppliers14 claims14 services$12.58 avg. paid by Medicare
Tubing used with positive airway pressure device A7037
DME-Other DME · category DE001N
3 suppliers15 claims15 services$9.85 avg. paid by Medicare
Filter, disposable, used with positive airway pressure device A7038
DME-Other DME · category DE001N
4 suppliers26 claims140 services$1.52 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 11

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

Nurse Practitioner (Adult Health)
2010 SPRINGFIELD AVE
MAPLEWOOD, NJ 07040
Durable Medical Equipment & Medical Supplies (Customized Equipment)
2010 SPRINGFIELD AVE, SUITE 102
MAPLEWOOD, NJ 07040
Clinic/Center (Mental Health (Including Community Mental Health Center))
2010 SPRINGFIELD AVE
MAPLEWOOD, NJ 07040
Internal Medicine (Cardiovascular Disease)
2010 SPRINGFIELD AVE
MAPLEWOOD, NJ 07040
Nurse Practitioner (Family)
2010 SPRINGFIELD AVE, #101
MAPLEWOOD, NJ 07040
Specialist
2010 SPRINGFIELD AVE
MAPLEWOOD, NJ 07040
Psychiatry & Neurology (Psychiatry)
2010 SPRINGFIELD AVE
MAPLEWOOD, NJ 07040
Nurse Practitioner (Primary Care)
2010 SPRINGFIELD AVE
MAPLEWOOD, NJ 07040

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 Sunil Patel's NPI number?

The NPI number for Sunil Patel is 1255354726. It was assigned to this individual provider in the NPPES registry on July 25, 2006.

Where is Sunil Patel located?

Sunil Patel practices at 2010 Springfield Ave, Maplewood, NJ 07040. The listed phone number is (973) 275-9500.

What is Sunil Patel's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Cardiovascular Disease, with taxonomy code 207RC0000X.

Is Sunil Patel enrolled in Medicare?

Yes. Sunil Patel 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.

What insurance does Sunil Patel accept?

Health plans from Ambetter Health and Ambetter Health of Delaware list Sunil 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 Sunil Patel affiliated with any hospitals?

According to CMS data, Sunil Patel is affiliated with Newark Beth Israel Medical Center.

When was this NPI record last updated?

The NPPES record for Sunil Patel was last updated on March 4, 2014. NPI Profile syncs with the weekly NPPES data releases published by CMS.