NIRAJ UPADHAYAY MD
NPI 1497947964
Hospitalist in Edgewood, KY

Q: What is Niraj Upadhayay's NPI number?

The NPI number for Niraj Upadhayay is 1497947964. It was assigned to this individual provider in the NPPES registry on August 17, 2007.

Q: What is Niraj Upadhayay's specialty?

The primary specialty registered for this NPI is Hospitalist with taxonomy code 208M00000X.

Q: When was this NPI record last updated?

The NPPES record for Niraj Upadhayay was last updated on March 15, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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 August 17, 2007PECOS EnrolledAccepts Medicare Assignment

90.38/100

CMS Quality Rating

1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017(859) 301-8074(859) 301-4945 Get Directions Write a Review

NPPES record last updated: March 15, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Niraj Upadhayay Md NPPES

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

NIRAJ UPADHAYAY MD (NPI 1497947964) is an individual hospitalist provider in Edgewood, Kentucky, licensed in Kentucky (46322) and active in the NPI registry since August 2007. He is enrolled in Medicare PECOS, is affiliated with St Elizabeth Edgewood, and is a graduate of Other (2005).

NPPES Registry Identity

NPI1497947964

Entity TypeIndividualMale

Primary Taxonomy208M00000X

Provider Legal NameNIRAJ UPADHAYAYCredential: MD

Location Address1 MEDICAL VILLAGE DREdgewood, KY 41017

Mailing AddressPo Box 635283Cincinnati, OH 45263-5283 · (859) 301-8074 · Fax (859) 301-4945

Phone(859) 301-8074

Fax(859) 301-4945

Sole ProprietorNo

Medical School CMSOtherGraduated 2005

Enumeration DateAugust 17, 2007

Last NPPES UpdateMarch 15, 2022

NPPES CertifiedMarch 15, 2022

✔ NPI 1497947964 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyHospitalistAllopathic & Osteopathic Physicians

Taxonomy Code208M00000X

Licenses✔ Licensed in KY · 46322✔ Licensed in IL · 036125356

Definition

Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients.

Also ListedInternal MedicineTaxonomy 207R00000X · License 46322 (KY)

1 MEDICAL VILLAGE DR, Edgewood, KY 41017

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Other Identifiers 5

Medicaid036125356IL

Other721089IL · Aetna

Medicaid0087703OH

Other3932056IL · Bcbs

Medicaid7100259620KY

Accepted Insurance

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

Niraj Upadhayay 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 ID9638364458

PECOS Enrollment IDI20130802000783

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 5

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 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.

550 services181 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.

147 services145 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.

127 services123 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.

39 services34 patients

Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99231

Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.

25 services13 patients

Hospital Affiliations CMS Care Compare

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

St Elizabeth Edgewood

Acute Care Hospitals · Edgewood, KY

5/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number180035

Location1 Medical Village DriveEdgewood, KY 41017 · Kenton County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 41017 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

$122.77 typical visit price

range $52.76 – $162.27

Typical copayment $30.69 (range $13.19 – $40.56)

Most-billed visit code 99204

Established Patient

$93.94 typical visit price

range $16.53 – $131.99

Typical copayment $23.48 (range $4.13 – $32.99)

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.

90.38/100

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

Scored through an Alternative Payment Model

Quality

80.76

Promoting Interoperability

100

Improvement Activities

Referred Medical Equipment & Supplies CMS DME claims 2

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

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390

DME-Oxygen and Supplies · category DC002N

3 suppliers23 claims23 services$60.79 avg. paid by Medicare

Portable oxygen concentrator, rental E1392

DME-Oxygen and Supplies · category DC002N

1 supplier12 claims12 services$31.74 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.

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