DR. AJAY PILLAI M.D.
NPI 1376556043
Internal Medicine - Pulmonary Disease in Darby, PA

Active since August 14, 2006PECOS Enrolled
75/100
CMS Quality Rating
1503 LANSDOWNE AVE, SUITE 3007, DARBY, PA 19023(610) 534-6140(610) 534-6144 Get Directions Write a Review

NPPES record last updated: March 15, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Ajay Pillai M.d. NPPES

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

DR. AJAY PILLAI M.D. (NPI 1376556043) is an individual pulmonary disease provider in Darby, Pennsylvania, licensed in Pennsylvania (MD417885) and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1376556043
Entity TypeIndividualMale
Primary Taxonomy207RP1001X
Provider Legal NameDR. AJAY PILLAICredential: M.D.
Location Address1503 LANSDOWNE AVE, SUITE 3007Darby, PA 19023-1330
Mailing Address1503 Lansdowne Ave, Suite 3007Darby, PA 19023-1330 · (610) 534-6140 · Fax (610) 534-6144
Fax(610) 534-6144
Sole ProprietorNo
Enumeration DateAugust 14, 2006
Last NPPES UpdateMarch 15, 2021
NPPES CertifiedMarch 15, 2021
NPI 1376556043 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyInternal Medicine · Pulmonary DiseaseAllopathic & Osteopathic Physicians
Taxonomy Code207RP1001X
License Licensed in PA · MD417885
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 Medicine · Critical Care MedicineTaxonomy 207RC0200X · License MD417885 (PA)
Also ListedInternal Medicine · Sleep MedicineTaxonomy 207RS0012X · License MD417885 (PA)
1503 LANSDOWNE AVE, Darby, PA 19023

Other Identifiers 10

Other1106922PA · Cigna Insurance Co.
Other079557PA · Aetna U.s. Healthcare
Other11358PA · Elderhealth
Other1616703PA · Highmark Blue Shield
OtherP3426483PA · Oxford Health Plan
Other10093634001PA · Americhoice M/c & M/a
Other2294734000PA · Independence Blue Cross
OtherI07021PA · Seniorpartner, Healthpart
Medicaid1009363640001PA
Other30015352PA · Keystone Mercy Health Pln

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 (PECOS)

Dr. Ajay Pillai M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 11

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.

Nursing facility ventilation assistance and management 94004
Nursing facility ventilation assistance and management involves using special equipment to help patients breathe. Trained healthcare professionals monitor and adjust the equipment to ensure optimal breathing support. It's important for patients with respiratory difficulties or conditions.
370 services62 patients
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more 99308
A follow-up nursing facility visit per day is a daily check-up service provided by healthcare professionals. It lasts around 15 minutes and involves assessing your health status, monitoring your recovery progress, and addressing any concerns you may have about your health or treatment.
223 services77 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.
126 services92 patients
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes 99307
A follow-up nursing facility visit per day typically lasts about 10 minutes. This service involves a healthcare professional checking on your health status, answering any questions you may have, and monitoring your progress. This routine check ensures your recovery is on track and any concerns are addressed promptly.
90 services22 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.
47 services13 patients
Initial nursing facility care with high level of medical decision making, per day, if using time, 50 minutes or more 99306
An initial nursing facility visit is your first meeting with your healthcare team at a nursing facility. Lasting typically 45 minutes, this appointment involves a comprehensive health assessment and the creation of your personalized care plan. It's a crucial step to ensure your health and well-being.
37 services36 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19023 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
$137.17 typical visit price
range $59.88 – $180.99
Typical copayment $34.29 (range $14.97 – $45.24)
Most-billed visit code 99204
Established Patient
$105.21 typical visit price
range $19.30 – $147.29
Typical copayment $26.30 (range $4.82 – $36.82)
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.

75/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice

Reported Quality Measures

Documentation of Current Medications in the Medical Record
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.
79%2,607 patients2/55-star benchmark: 100%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
99%389 patients4/55-star benchmark: 100%
Medication Reconciliation
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
97%567 patients4/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
96%470 patients4/55-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
92%463 patients5/55-star benchmark: 90%
Preventive Care and Screening: Influenza Immunization
Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization
68%603 patients4/55-star benchmark: 88%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Patients screenedForUse: 99% · 560 patients
Patients tobacco: 96% · 560 patients
83%80 patients4/55-star benchmark: 98%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
100%470 patients5/55-star benchmark: 100%
Secure Messaging
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…
0%470 patients1/55-star benchmark: 79%
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 24

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
14 suppliers125 claims125 services$32.02 avg. paid by Medicare
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable A7003
DME-Other DME · category DE000N
2 suppliers25 claims50 services$1.15 avg. paid by Medicare
Full face mask used with positive airway pressure device, each A7030
DME-Other DME · category DE001N
10 suppliers75 claims75 services$72.48 avg. paid by Medicare
Face mask interface, replacement for full face mask, each A7031
DME-Other DME · category DE001N
9 suppliers63 claims186 services$27.53 avg. paid by Medicare
Cushion for use on nasal mask interface, replacement only, each A7032
DME-Other DME · category DE001N
14 suppliers55 claims318 services$15.22 avg. paid by Medicare
Pillow for use on nasal cannula type interface, replacement only, pair A7033
DME-Other DME · category DE001N
8 suppliers37 claims211 services$12.14 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.

Psychologist
1503 LANSDOWNE AVE, SUITE 3008
DARBY, PA 19023
Internal Medicine (Infectious Disease)
1503 LANSDOWNE AVE, SUITE 3010
DARBY, PA 19023
Internal Medicine (Cardiovascular Disease)
1503 LANSDOWNE AVE, 3001
DARBY, PA 19023
Pharmacy (Community/Retail Pharmacy)
1503 LANSDOWNE AVE, SUITE 1000
DARBY, PA 19023
Physician Assistant
1503 LANSDOWNE AVE, 1ST FLOOR
DARBY, PA 19023
Pharmacist
1503 LANSDOWNE AVE, SUITE 1000
DARBY, PA 19023
Psychiatry & Neurology (Psychiatry)
1503 LANSDOWNE AVE, SUITE 3005
DARBY, PA 19023
Pediatrics
1503 LANSDOWNE AVE, STE 3002 LANSDOWNE PARK PEDIATRICS
DARBY, PA 19023

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 Ajay Pillai's NPI number?

The NPI number for Ajay Pillai is 1376556043. It was assigned to this individual provider in the NPPES registry on August 14, 2006.

Where is Ajay Pillai located?

Ajay Pillai practices at 1503 Lansdowne Ave Suite 3007, Darby, PA 19023. The listed phone number is (610) 534-6140.

What is Ajay Pillai's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Pulmonary Disease, with taxonomy code 207RP1001X.

Is Ajay Pillai enrolled in Medicare?

Yes. Ajay Pillai is registered in the Medicare PECOS enrollment system.

What insurance does Ajay Pillai accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Ambetter from Buckeye Health Plan list Ajay Pillai 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.

When was this NPI record last updated?

The NPPES record for Ajay Pillai was last updated on March 15, 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.