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SANJAY PATEL
NPI 1295723575
Internal Medicine - Sleep Medicine in Pittsburgh, PA

Active since October 11, 2005PECOS EnrolledAccepts Medicare Assignment
77.5/100
CMS Quality Rating
3601 5TH AVE, 4TH FLOOR FALK COMPREHENSIVE LUNG CENTER, PITTSBURGH, PA 15213(412) 648-6161 Get Directions Write a Review

NPPES record last updated: May 24, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 24, 2021, Apr 3, 2016 (2 updates tracked since 2016).

About Sanjay Patel NPPES

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

SANJAY PATEL (NPI 1295723575) is an individual sleep medicine provider in Pittsburgh, Pennsylvania, licensed in Pennsylvania (MD456301) and active in the NPI registry since October 2005. He is enrolled in Medicare PECOS, is affiliated with Upmc Presbyterian Shadyside, and is a graduate of Harvard Medical School (1996).

NPPES Registry Identity

NPI1295723575
Entity TypeIndividualMale
Primary Taxonomy207RS0012X
Provider Legal NameSANJAY PATEL
Location Address3601 5TH AVE, 4TH FLOOR FALK COMPREHENSIVE LUNG CENTERPittsburgh, PA 15213-3403
Mailing Address2 Hot Metal St, Quantum One Suite 001Pittsburgh, PA 15203-2348
Phone(412) 648-6161
Sole ProprietorNo
Medical School CMSHarvard Medical SchoolGraduated 1996
Enumeration DateOctober 11, 2005
Last NPPES UpdateMay 24, 20212 updates tracked since enumeration
✔ NPI 1295723575 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Sleep MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207RS0012X
License✔ Licensed in PA · MD456301
Definition
An Internist who practices Sleep Medicine is certified in the subspecialty of sleep medicine and specializes in the clinical assessment, physiologic testing, diagnosis, management and prevention of sleep and circadian rhythm disorders. Sleep specialists treat patients of any age and use multidisciplinary approaches. Disorders managed by sleep specialists include, but are not limited to, sleep related breathing disorders, insomnia, hypersomnias, circadian rhythm sleep disorders, parasomnias and sleep related movement disorders.
3601 5TH AVE, Pittsburgh, PA 15213
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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

Sanjay Patel 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 ID8123053485
PECOS Enrollment IDI20151217000421
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 4

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 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.
36 services19 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.
24 services20 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.
15 services14 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.
14 services14 patients

Hospital Affiliations CMS Care Compare

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

Upmc Presbyterian Shadyside

Acute Care Hospitals · Pittsburgh, PA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390164
Location200 Lothrop StreetPittsburgh, PA 15213 · Allegheny County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 15213 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
$126.34 typical visit price
range $54.64 – $166.87
Typical copayment $31.58 (range $13.66 – $41.71)
Most-billed visit code 99204
Established Patient
$96.82 typical visit price
range $17.33 – $135.84
Typical copayment $24.20 (range $4.33 – $33.96)
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.

77.5/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality68.61
Promoting Interoperability100
Improvement Activities40
Cost56.4

Referred Medical Equipment & Supplies CMS DME claims 8

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

Tubing with integrated heating element for use with positive airway pressure device A4604
DME-Other DME · category DE001N
6 suppliers31 claims31 services$34.22 avg. paid by Medicare
Full face mask used with positive airway pressure device, each A7030
DME-Other DME · category DE001N
5 suppliers21 claims21 services$85.24 avg. paid by Medicare
Face mask interface, replacement for full face mask, each A7031
DME-Other DME · category DE001N
4 suppliers20 claims59 services$30.38 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
5 suppliers17 claims17 services$54.56 avg. paid by Medicare
Headgear used with positive airway pressure device A7035
DME-Other DME · category DE001N
8 suppliers25 claims25 services$17.93 avg. paid by Medicare
Filter, disposable, used with positive airway pressure device A7038
DME-Other DME · category DE001N
7 suppliers30 claims168 services$1.93 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 20

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

CHRISTINE PEOPLES
Internal Medicine (Rheumatology)
3601 5TH AVE, SUITE 3B FALK MEDICAL BUILDING
PITTSBURGH, PA 15213
Allegheny County (412) 647-6700
RIMA ABDEL MASSIH
Internal Medicine
3601 5TH AVE, SUITE 3A
PITTSBURGH, PA 15213
Allegheny County (412) 648-6273
NOEL PREVOST
Physician Assistant
3601 5TH AVE, SUITE 5A FALK MEDICAL BUILDING
PITTSBURGH, PA 15213
Allegheny County (412) 648-3263
MELODY IVES CRNP
Internal Medicine (Endocrinology, Diabetes & Metabolism)
3601 5TH AVE
PITTSBURGH, PA 15213
Allegheny County (412) 383-8700
PETER VELDKAMP
Specialist
3601 5TH AVE, 610 FALK MEDICAL BUILDING
PITTSBURGH, PA 15213
Allegheny County (412) 647-5399
DR. BRIAN A. POTOSKI PHARM.D.
Pharmacist (Pharmacotherapy)
3601 5TH AVE, FALK MEDICAL BLDG., SUITE 3A
PITTSBURGH, PA 15213
Allegheny County (412) 648-6401
MS. LAURA ELIZABETH HARNISH RDN
Dietitian, Registered
3601 5TH AVE, STE 1-B, ROOM 145-B
PITTSBURGH, PA 15213
Allegheny County (412) 692-4497
LAURA FERRIS
Specialist
3601 5TH AVE, SUITE 5A FALK MEDICAL BUILDING
PITTSBURGH, PA 15213
Allegheny County (412) 648-3263

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 Sanjay Patel's NPI number?

The NPI number for Sanjay Patel is 1295723575. It was assigned to this individual provider in the NPPES registry on October 11, 2005.

Where is Sanjay Patel located?

Sanjay Patel practices at 3601 5th Ave 4th Floor Falk Comprehensive Lung Center, Pittsburgh, PA 15213. The listed phone number is (412) 648-6161.

What is Sanjay Patel's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Sleep Medicine, with taxonomy code 207RS0012X.

Is Sanjay Patel enrolled in Medicare?

Yes. Sanjay 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.

Is Sanjay Patel affiliated with any hospitals?

According to CMS data, Sanjay Patel is affiliated with Upmc Presbyterian Shadyside.

When was this NPI record last updated?

The NPPES record for Sanjay Patel was last updated on May 24, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.