HIREN GHANSHYAMBHAI PATEL M.D.
NPI 1316202823
Internal Medicine in Paterson, NJ

Q: What is Hiren Patel's NPI number?

The NPI number for Hiren Patel is 1316202823. It was assigned to this individual provider in the NPPES registry on July 10, 2012.

Q: What is Hiren Patel's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Hiren Patel was last updated on July 2, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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 July 10, 2012PECOS EnrolledAccepts Medicare Assignment

67.81/100

CMS Quality Rating

703 MAIN ST, PATERSON, NJ 07503(973) 754-2431 Get Directions Write a Review

NPPES record last updated: July 2, 2018. Verified against the NPPES registry weekly; last sync: October 18, 2026.

On this page

About Hiren Ghanshyambhai Patel M.d. NPPES

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

HIREN GHANSHYAMBHAI PATEL M.D. (NPI 1316202823) is an individual internal medicine provider in Paterson, New Jersey, licensed in Alabama (MD.36944) and active in the NPI registry since July 2012. He is enrolled in Medicare PECOS, maintains a secondary practice location in Paterson, and is a graduate of Other (2010).

NPPES Registry Identity

NPI1316202823

Entity TypeIndividualMale

Primary Taxonomy207R00000X

Provider Legal NameHIREN GHANSHYAMBHAI PATELCredential: M.D.

Location Address703 MAIN STPaterson, NJ 07503

Mailing Address1722 Pine St Ste 503Montgomery, AL 36106-1160 · (334) 293-8736 · Fax (334) 293-8738

Phone(973) 754-2431

Sole ProprietorYes

Medical School CMSOtherGraduated 2010

Enumeration DateJuly 10, 2012

Last NPPES UpdateJuly 2, 2018

✔ NPI 1316202823 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

License✔ Licensed in AL · MD.36944

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.

703 MAIN ST, Paterson, NJ 07503

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Secondary Practice Location 1

Location 1703 Main StPaterson, NJ 07503-2621 · Phone (973) 754-2431

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Alabama.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

Hiren Ghanshyambhai 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 ID4385996545

PECOS Enrollment IDI20181016003293

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 Reassignment

Medicare enrollment records show Hiren Patel reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Jackson Hospital And Clinic Inc

868 mi

Cardiovascular Disease

115 HERREN HILL RD
Tallassee, AL 36078

Reassigned Medicare billing, Alabama enrollment
248 clinicians in this Medicare group

NPI 1891156469 (334) 264-9191

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.

Biopsy of large bowel using a flexible endoscope 45380

A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.

183 services181 patients

Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239

This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.

177 services164 patients

Removal of polyps or growths of large bowel using an endoscope with mechanical snare 45385

This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.

155 services153 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.

80 services60 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.

77 services62 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.

64 services35 patients

Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope with mechanical snare 43251

This procedure involves the use of a thin, flexible instrument called an endoscope to visualize and remove abnormal growths, known as polyps, from the esophagus, stomach, or upper small bowel. A tool called a mechanical snare is used to safely cut and remove these growths.

42 services40 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.

38 services38 patients

Balloon dilation of esophagus, stomach, and/or upper small bowel using a flexible endoscope, less than 3.0 cm 43249

This procedure involves using a flexible tube with a camera, called an endoscope, to gently expand narrowed areas in your esophagus, stomach, or upper small bowel. A small balloon is inflated, making it easier for food and liquid to pass through. It's safe and effective.

32 services31 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

26 services22 patients

Diagnostic exam of large bowel using a flexible endoscope 45378

This procedure, known as a colonoscopy, involves using a flexible tube with a light and camera to examine the large intestine. It helps detect any abnormalities such as polyps or inflammation. It's a standard procedure to ensure gut health.

20 services20 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.

19 services15 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

17 services17 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.

13 services11 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 07503 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.

67.81/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Individually scored

Quality

73.69

Promoting Interoperability

Improvement Activities

Cost

20.69

Reported Quality Measures

Advance Care Plan

46%1,385 patients2/55-star benchmark: 100%

Breast Cancer Screening

26%1,112 patients2/55-star benchmark: 93%

Cervical Cancer Screening

19%1,044 patients1/55-star benchmark: 98%

Closing the Referral Loop: Receipt of Specialist Report

44%100 patients3/55-star benchmark: 87%

Colorectal Cancer Screening

84%2,150 patients4/55-star benchmark: 88%

Controlling High Blood Pressure

61%1,188 patients3/55-star benchmark: 91%

Coronary Artery Disease (CAD): Beta-Blocker Therapy Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <= 40%)

81%26 patients4/55-star benchmark: 99%

Dementia: Cognitive Assessment

4%27 patients

Diabetes: Eye Exam

7%480 patients1/55-star benchmark: 100%

Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)

Lower rates are better for this measure.

31%480 patients4/55-star benchmark: 91%

Documentation of Current Medications in the Medical Record

92%4,069 patients4/55-star benchmark: 100%

e-Prescribing

99%492 patients4/55-star benchmark: 100%

Falls: Screening for Future Fall Risk

11%1,171 patients1/55-star benchmark: 100%

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

27%3,013 patients2/55-star benchmark: 98%

Preventive Care and Screening: Screening for Depression and Follow-Up Plan

12%2,493 patients1/55-star benchmark: 97%

Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

24%2,309 patients2/55-star benchmark: 61%

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Patients combinedPopulations: 68% · 2,205 patients

Patients screened: 73% · 2,205 patients

46%213 patients2/55-star benchmark: 100%

Provide Patients Electronic Access to Their Health Information

72%205 patients3/55-star benchmark: 100%

Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

81%944 patients4/55-star benchmark: 91%

Use of High-Risk Medications in Older Adults

Lower rates are better for this measure.

Patients appropriateDiagnosis: 1% · 1,217 patients

Patients totalRate: 13% · 1,247 patients

14%1,247 patients3/55-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.

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.

DR. SETAREH SHAMS MD

Obstetrics & Gynecology (Obstetrics)