DR. SUMIT P. SHAH M.D.
NPI 1346439213
Ophthalmology - Retina Specialist in New Brunswick, NJ

Q: What is Sumit Shah's NPI number?

The NPI number for Sumit Shah is 1346439213. It was assigned to this individual provider in the NPPES registry on October 17, 2007.

Q: What is Sumit Shah's specialty?

The primary specialty registered for this NPI is Ophthalmology, specializing in Retina Specialist, with taxonomy code 207WX0107X.

Q: When was this NPI record last updated?

The NPPES record for Sumit Shah was last updated on February 5, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months 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 October 17, 2007PECOS EnrolledAccepts Medicare Assignment

99.74/100

CMS Quality Rating

10 PLUM ST STE 600, NEW BRUNSWICK, NJ 08901(732) 220-1600(732) 466-9661 Get Directions Write a Review

NPPES record last updated: February 5, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 5, 2026, Aug 1, 2017 (2 updates tracked since 2017).

On this page

About Dr. Sumit P. Shah M.d. NPPES

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

DR. SUMIT P. SHAH M.D. (NPI 1346439213) is an individual retina specialist in New Brunswick, New Jersey, licensed in New Jersey (25MA09260500) and active in the NPI registry since October 2007. He is enrolled in Medicare PECOS, is affiliated with Robert Wood Johnson University Hospital, and is a graduate of Rutgers New Jersey Medical School (2005).

NPPES Registry Identity

NPI1346439213

Entity TypeIndividualMale

Primary Taxonomy207WX0107X

Provider Legal NameDR. SUMIT P. SHAHCredential: M.D.

Location Address10 PLUM ST STE 600New Brunswick, NJ 08901-2065

Mailing Address420 Mountain Ave Fl 4New Providence, NJ 07974-2736 · (908) 458-8330 · Fax (908) 967-5488

Phone(732) 220-1600

Fax(732) 466-9661

Sole ProprietorYes

Medical School CMSRutgers New Jersey Medical SchoolGraduated 2005

Enumeration DateOctober 17, 2007

Last NPPES UpdateFebruary 5, 20262 updates tracked since enumeration

NPPES CertifiedFebruary 5, 2026

✔ NPI 1346439213 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyOphthalmology · Retina SpecialistAllopathic & Osteopathic Physicians

Taxonomy Code207WX0107X

License✔ Licensed in NJ · 25MA09260500

Definition

An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases.

Also ListedOphthalmologyTaxonomy 207W00000X · License 25MA09260500 (NJ)

10 PLUM ST STE 600, New Brunswick, NJ 08901

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware.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. Sumit P. Shah 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 ID547310500

PECOS Enrollment IDI20130614000565

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 17

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.

Injection, faricimab-svoa, 0.1 mg J2777

Faricimab-svoa is a medication given through an injection into the eye to treat certain eye conditions. The 0.1 mg dosage helps control disease progression, improving vision and eye health. The procedure is done by a healthcare professional.

13,621 services39 patients

Imaging of retina 92134

Imaging of the retina is a non-invasive procedure that captures detailed images of your eye's interior. This helps detect conditions like macular degeneration or retinal detachment. It's painless and takes only a few minutes.

2,409 services769 patients

Injection of drug into eye 67028

An injection into the eye is a procedure where a medication is delivered directly into your eye to treat various conditions. A local anesthetic is applied to numb the eye, ensuring minimal discomfort. The drug helps manage diseases like macular degeneration or diabetic retinopathy.

2,170 services361 patients

Established patient complete exam of visual system 92014

An established patient complete exam of the visual system involves a thorough check of your eyes and vision. It assesses eye health, checks for diseases, and measures your ability to see clearly at different distances. It's a routine, non-invasive procedure.

2,031 services707 patients

Injection, aflibercept, 1 mg J0178

Aflibercept injection is a treatment for certain eye conditions that affect vision. It works by blocking abnormal blood vessel growth and leakage in the eye, which can cause vision loss. The medication is administered directly into the eye by a healthcare professional.

742 services93 patients

Extended exam of the back part of the eye with optic nerve drawing 92202

This procedure involves a detailed examination of the back part of your eye, focusing on the optic nerve, a crucial component for vision. A drawing or map of the optic nerve is created to help track any changes over time. This can help detect eye diseases early.

461 services322 patients

Established patient problem focused exam of visual system 92012

This is a routine check-up for existing patients focusing on the visual system. It involves examining your eyes to detect any potential issues or changes in your vision. It's a crucial part of maintaining good eye health.

358 services166 patients

Unclassified biologics J3590

Unclassified biologics are a type of treatment derived from living organisms. They can include a wide range of substances, such as vaccines, blood components, or genes, used to prevent or treat diseases. Each is specifically designed to interact with the body's natural defenses to promote healing.

240 services114 patients

Extended exam of the back part of the eye with retinal drawing 92201

This procedure involves a detailed examination of the back part of your eye, including the retina. It helps identify any abnormalities or issues. A retinal drawing is made to record findings. It's non-invasive and crucial for maintaining eye health.

176 services157 patients

Principal care management services for a single high-risk disease, first 30 minutes of clinical staff time directed by health care professional, per calendar month 99426

Principal care management services focus on managing a single high-risk disease. This involves a health care professional directing clinical staff for the first 30 minutes each month. The aim is to monitor your health, coordinate care, and provide necessary support for your disease management.

115 services32 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.

101 services101 patients

Photography of the retina 92250

Photography of the retina, also known as retinal imaging, is a non-invasive procedure that captures images of the back of your eye. This helps doctors identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. It's painless and quick, often part of a routine eye exam.

98 services78 patients

Principal care management services for a single high-risk disease, each additional 30 minutes of clinical staff time directed by health care professional, per calendar month 99427

Principal Care Management (PCM) services focus on managing a single high-risk disease. It involves additional 30 minutes of clinical staff time per month, overseen by a healthcare professional. This includes monitoring your health, coordinating care, and developing a personalized treatment plan.

65 services27 patients

Exam of retinal blood vessels using a special camera after injection of a dye 92235

This procedure, known as a fluorescein angiography, involves taking images of the back of your eye. A dye is injected into your arm that travels to your eye, highlighting the blood vessels in your retina. This helps identify any abnormalities.

56 services53 patients

Compounded drug, not otherwise classified J7999

A compounded drug is a personalized medication created to meet unique patient needs. If you can't take standard drugs due to allergies or need a specific dosage not commercially available, a pharmacist can mix ingredients to make a drug specifically for you.

50 services14 patients

2d ultrasound scan of eye tissue and structures 76512

A 2D ultrasound scan of eye tissue and structures is a non-invasive procedure that uses sound waves to create images of your eye. It helps doctors to examine your eye's internal structures, detect abnormalities, and plan for treatments if needed.

35 services25 patients

New patient complete exam of visual system 92004

A new patient complete exam of the visual system is a thorough evaluation of your eyes and vision. It checks for any potential issues and assesses overall eye health. It includes tests for visual acuity, eye movement, and light response.

18 services18 patients

Hospital Affiliations CMS Care Compare

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

Robert Wood Johnson University Hospital

Acute Care Hospitals · New Brunswick, NJ

2/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number310038

LocationOne Robert Wood Johnson PlaceNew Brunswick, NJ 08901 · Middlesex County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 08901 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.

99.74/100

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

Individually scored

Quality

99.7

Improvement Activities

Reported Quality Measures

Age-Related Macular Degeneration (AMD): Dilated Macular Examination

98%748 patients4/55-star benchmark: 100%

Diabetes: Eye Exam

100%600 patients5/55-star benchmark: 100%

Diabetic Macular Edema - Loss of Visual Acuity

100%128 patients

Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

96%580 patients4/55-star benchmark: 100%

Documentation of Current Medications in the Medical Record

100%6,640 patients5/55-star benchmark: 100%

Glaucoma Intraocular Pressure Reduction

92%248 patients

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

Patients combinedPopulations: 100% · 1,636 patients

Patients screened: 100% · 1,636 patients

97%73 patients4/55-star benchmark: 100%

Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% OR Documentation of a Plan of Care

100%156 patients

Use of High-Risk Medications in Older Adults

Lower rates are better for this measure.

Patients appropriateDiagnosis: 0% · 1,718 patients

Patients totalRate: 0% · 1,718 patients

0%1,718 patients5/55-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 5

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

DR. ELIZABETH O'TOOLE TEGINS MD

Ophthalmology