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DHAVAL UPADHYAY MD
NPI 1386149169
Internal Medicine in Gainesville, FL

Active since March 26, 2018PECOS EnrolledAccepts Medicare Assignment
75/100
CMS Quality Rating
1147 NW 64TH TER, GAINESVILLE, FL 32605(352) 333-5159 Get Directions Write a Review

NPPES record last updated: April 11, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Apr 11, 2025, Oct 19, 2022, Mar 26, 2018 (3 updates tracked since 2018).

About Dhaval Upadhyay Md NPPES

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

DHAVAL UPADHYAY MD (NPI 1386149169) is an individual internal medicine provider in Gainesville, Florida, licensed in Florida (ME157987) and active in the NPI registry since March 2018. He is enrolled in Medicare PECOS, is affiliated with Adventhealth Orlando, and is a graduate of Other (2017).

NPPES Registry Identity

NPI1386149169
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameDHAVAL UPADHYAYCredential: MD
Location Address1147 NW 64TH TERGainesville, FL 32605-4218
Mailing Address1147 Nw 64th TerGainesville, FL 32605-4218 · (352) 333-5159
Phone(352) 333-5159
Sole ProprietorYes
Medical School CMSOtherGraduated 2017
Enumeration DateMarch 26, 2018
Last NPPES UpdateApril 11, 20253 updates tracked since enumeration
NPPES CertifiedApril 11, 2025
✔ NPI 1386149169 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in FL · ME157987
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.
Also ListedHospitalistTaxonomy 208M00000X · License ME157987 (FL)
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
1147 NW 64TH TER, Gainesville, FL 32605
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include AvMed.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

Dhaval Upadhyay Md 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 ID4486059755
PECOS Enrollment IDI20220817004039
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 Reassignments

5

Medicare enrollment records show Dhaval Upadhyay reassigns Medicare billing to 5 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Hni Medical Services Of Florida, LLC
63 mi
Internal Medicine
1 SHIRCLIFF WAY
Jacksonville, FL 32204
  • Reassigned Medicare billing, Florida enrollment
  • 492 clinicians in this Medicare group
NPI 1679048284 (512) 730-3060
Pioneer Medical Group, Pl
110 mi
Internal Medicine
13067 N TELECOM PKWY
Temple Terrace, FL 33637
  • Reassigned Medicare billing, Florida enrollment
  • 229 clinicians in this Medicare group
NPI 1710315775 (813) 779-6303
Hni Hospital Services Of Florida, LLC
197 mi
Critical Care Medicine
615 N BONITA AVE
Panama City, FL 32401
  • Reassigned Medicare billing, Florida enrollment
  • 281 clinicians in this Medicare group
NPI 1144851411 (440) 572-5000
Hospital Medicine Services Of Fl, LLC
290 mi
Hospitalist
20900 BISCAYNE BLVD
Aventura, FL 33180
  • Reassigned Medicare billing, Florida enrollment
  • 861 clinicians in this Medicare group
NPI 1710684857 (305) 682-7000
Hospital Physician Services - Southeast Professional Corporation
296 mi
Hospitalist
2151 W SPRING ST
Monroe, GA 30655
  • Reassigned Medicare billing, Florida enrollment
  • 118 clinicians in this Medicare group
NPI 1760410385 (770) 267-8461

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 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.
671 services229 patients
Hospital discharge day management, more than 30 minutes 99239
Hospital discharge day management over 30 minutes involves a detailed process to ensure a smooth transition from hospital to home. It includes final examinations, discussion of your hospital stay, post-discharge instructions, and coordinating follow-up care.
223 services212 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.
116 services71 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
61 services60 patients

Hospital Affiliations CMS Care Compare

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

Adventhealth Orlando

Acute Care Hospitals · Orlando, FL
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number100007
Location601 E Rollins StOrlando, FL 32803 · Orange County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32605 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
$130.04 typical visit price
range $56.00 – $171.84
Typical copayment $32.51 (range $14.00 – $42.96)
Most-billed visit code 99204
Established Patient
$99.16 typical visit price
range $17.57 – $139.16
Typical copayment $24.79 (range $4.39 – $34.79)
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

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.

KENNETH ABBOTT
Student in an Organized Health Care Education/Training Program
1147 NW 64TH TER
GAINESVILLE, FL 32605
Alachua County (352) 333-5152
AZAN HAQUE
Student in an Organized Health Care Education/Training Program
1147 NW 64TH TER
GAINESVILLE, FL 32605
Alachua County (352) 333-5982
POOJA SANAT PATEL
Student in an Organized Health Care Education/Training Program
1147 NW 64TH TER
GAINESVILLE, FL 32605
Alachua County (352) 333-5982
COLLIN BUFANO
Emergency Medicine
1147 NW 64TH TER
GAINESVILLE, FL 32605
Alachua County (352) 333-4000
DR. INSHERAH SUGHAYER MD, LMHC
Student in an Organized Health Care Education/Training Program
1147 NW 64TH TER
GAINESVILLE, FL 32605
Alachua County (352) 333-5984
ERICA LEONETTE BRASCHI JORDAN
Student in an Organized Health Care Education/Training Program
1147 NW 64TH TER
GAINESVILLE, FL 32605
Alachua County (352) 333-5159
BRADLEY ELLIS KASPER BS
Student in an Organized Health Care Education/Training Program
1147 NW 64TH TER
GAINESVILLE, FL 32605
Alachua County (352) 213-8574
BARBARA SUENING DO
Student in an Organized Health Care Education/Training Program
1147 NW 64TH TER
GAINESVILLE, FL 32605
Alachua County (352) 333-5159

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 Dhaval Upadhyay's NPI number?

The NPI number for Dhaval Upadhyay is 1386149169. It was assigned to this individual provider in the NPPES registry on March 26, 2018.

Where is Dhaval Upadhyay located?

Dhaval Upadhyay practices at 1147 NW 64th Ter, Gainesville, FL 32605. The listed phone number is (352) 333-5159.

What is Dhaval Upadhyay's specialty?

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

Is Dhaval Upadhyay enrolled in Medicare?

Yes. Dhaval Upadhyay 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.

Which organizations bill Medicare for Dhaval Upadhyay's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Dhaval Upadhyay reassigns Medicare benefits to 5 organizations: Hni Medical Services Of Florida, LLC (Jacksonville, FL), Pioneer Medical Group, Pl (Temple Terrace, FL), Hni Hospital Services Of Florida, LLC (Panama City, FL), Hospital Medicine Services Of Fl, LLC (Aventura, FL) and Hospital Physician Services - Southeast Professional Corporation (Monroe, GA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Dhaval Upadhyay's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Dhaval Upadhyay accept?

Health plans from AvMed list Dhaval Upadhyay 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 Dhaval Upadhyay affiliated with any hospitals?

According to CMS data, Dhaval Upadhyay is affiliated with Adventhealth Orlando.

When was this NPI record last updated?

The NPPES record for Dhaval Upadhyay was last updated on April 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.