DR. SAMIR G PATEL MD
NPI 1588659296
Internal Medicine in Spotswood, NJ
Quality Rating: 92.77 out of 100 score
NPI Status: Active since September 19, 2005
Contact Information
407 MAIN ST STE 1
SPOTSWOOD, NJ
ZIP 08884
Phone: (732) 416-0065
- Individual
- Male
- Years of Experience 34
- Internal Medicine
- PECOS Enrolled
- Accepts Medicare Approved Payment
- Medicare Quality Reporting
About SAMIR PATEL
Samir Patel is an internist established in Spotswood, New Jersey and his medical specialization is Internal Medicine with more than 34 years of experience. The healthcare provider is registered in the NPI registry with number 1588659296 assigned on September 2005. The practitioner's primary taxonomy code is 207R00000X with license number 25MA06726200 (NJ). The provider is registered as an individual and his NPI record was last updated 3 years ago.
- NPI
- 1588659296
- Provider Name
- DR. SAMIR G PATEL MD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 407 MAIN ST STE 1 SPOTSWOOD, NJ 08884
- Location Phone
- (732) 416-0065
- Mailing Address
- 6 SANIBEL CT MONROE TWP, NJ 08831
- Mailing Phone
- (732) 416-0065
- Mailing Fax
- Medical School Name
- OTHER
- Graduation Year
- 1990
- Is Sole Proprietor?
- No
- Enumeration Date
- 09-19-2005
- Last Update Date
- 08-04-2021
- Code Navigator
An internist like Samir Patel is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.
Samir Patel is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.
The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 92.77, based on four performance areas: quality, improvement activities, promoting interoperability, and cost. The purpose of this information is to help people with Medicare make informed decisions and incentivize doctors and clinicians to maximize performance. The following quality measures were reported for this provider: breast cancer screening, diabetes screening, diabetes: medical attention for nephropathy, documentation of current medications in the medical record, engagement of patients through implementation of improvements in patient portal, e-prescribing, pneumococcal vaccination status for older adults, preventive care and screening: body mass index (bmi) screening and follow-up plan, preventive care and screening: influenza immunization, provide patient access, security risk analysis, tobacco use and use of high-risk medications in the elderly.
The typical physician office visit costs for Medicare beneficiaries in this area are: $37.64 for a new patient copayment and $29.21 for an established patient copayment.
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Internal Medicine
- Taxonomy Code
- 207R00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 25MA06726200
- License State
- NJ
- Taxonomy Description
- 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.
- NPI Profile Information
- Primary Taxonomy
- Insurance Plans Accepted
- PECOS Enrollment and Medicare Status
- Durable Medical Equipment
- Physician Visit Costs
- Overall MIPS Quality Performance
- Quality Reporting
- Clinician Services
- Hospital Affiliations
- NPI Validation
- Other Providers Same Location
- Frequently Asked Questions
Location Map
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Ambetter Health of Delaware
- Clear Gold - EPO
- Clear Gold + Vision + Adult Dental - EPO
- Clear Silver - EPO
- Clear Silver + Vision + Adult Dental - EPO
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Elite Bronze - EPO
- Elite Bronze + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Everyday Gold - EPO
- Everyday Gold + Vision + Adult Dental - EPO
- Everyday Silver - EPO
- Everyday Silver + Vision + Adult Dental - EPO
- Focused Silver - EPO
Medicare
Medicaid
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 7897201 | MEDICAID (05) | NJ |
PECOS Enrollment and Medicare Participation Status
Samir Patel is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
PECOS PAC ID: 8123015161
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20040429001390
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Provider Referred Orders for Durable Medical Equipment, Devices & Supplies
The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.
Durable Medical Equipment
Other DME (D1E)
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (HCPCS:A4253)
21 DME suppliers used 38 Medicare Claims 111 Services Paid
Other DME (D1E)
Lancets, per box of 100 (HCPCS:A4259)
11 DME suppliers used 19 Medicare Claims 27 Services Paid
Other DME (D1E)
Walker, heavy duty, wheeled, rigid or folding, any type (HCPCS:E0149)
1 DME suppliers used 12 Medicare Claims 12 Services Paid
Hospital beds (D1B)
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress (HCPCS:E0260)
2 DME suppliers used 20 Medicare Claims 20 Services Paid
Other DME (D1E)
Iv pole (HCPCS:E0776)
1 DME suppliers used 20 Medicare Claims 20 Services Paid
Oxygen and supplies (D1C)
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)
3 DME suppliers used 32 Medicare Claims 32 Services Paid
Oxygen and supplies (D1C)
Portable oxygen concentrator, rental (HCPCS:E1392)
2 DME suppliers used 14 Medicare Claims 14 Services Paid
Wheelchairs (D1D)
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches (HCPCS:E2201)
1 DME suppliers used 16 Medicare Claims 17 Services Paid
Wheelchairs (D1D)
Standard wheelchair (HCPCS:K0001)
2 DME suppliers used 75 Medicare Claims 76 Services Paid
Wheelchairs (D1D)
Heavy duty wheelchair (HCPCS:K0006)
1 DME suppliers used 11 Medicare Claims 11 Services Paid
Wheelchairs (D1D)
Elevating leg rests, pair (for use with capped rental wheelchair base) (HCPCS:K0195)
1 DME suppliers used 23 Medicare Claims 23 Services Paid
Prosthetic and Orthotic Devices
Prosthetic/Orthotic devices (D1F)
Ostomy pouch, closed, with barrier attached, with filter (1 piece), each (HCPCS:A4416)
1 DME suppliers used 16 Medicare Claims 960 Services Paid
Drugs and Nutritional Products
Enteral and parenteral (O1C)
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape (HCPCS:B4035)
1 DME suppliers used 20 Medicare Claims 554 Services Paid
Enteral and parenteral (O1C)
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (HCPCS:B4154)
1 DME suppliers used 11 Medicare Claims 5376 Services Paid
Enteral and parenteral (O1C)
Enteral nutrition infusion pump, any type (HCPCS:B9002)
1 DME suppliers used 12 Medicare Claims 12 Services Paid
Physician Visit Costs
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 08884 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $150.56
- Minimum New Patient Price $66.45
- Maximum New Patient Price $198.48
- Average New Patient Copayment $37.64
- Minimum New Patient Copayment $16.61
- Maximum New Patient Copayment $49.62
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $116.86
- Minimum Established Patient Price $21.27
- Maximum Established Patient Price $162.58
- Average Established Patient Copayment $29.21
- Minimum Established Patient Copayment $5.31
- Maximum Established Patient Copayment $40.64
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Overall MIPS Quality Performance
The Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS Quality Payment Program (QPP). The MIPS program affects clinician reimbursement for Part B covered professional services and also rewards them for improving the quality of patient care and outcomes.
-
Final Score: 92.77 out of 100
The MIPS program evaluates providers across multiple categories with a specific weight for each category resulting a in a MIPS final score that ranges from 0 to 100 points. The MIPS Final Score determines whether providers receive a negative, neutral or positive MIPS payment adjustment.
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Quality Score: 96.67
The Quality category assesses providers performance on clinical practices and patient outcomes under the traditional MIPS program. The quality measures help identify the quality of healthcare processes, outcomes, and patient experiences. The Quality measure category compromises 40% providers final MPIS scores.
There are six collection types for MIPS quality measures: Electronic Clinical Quality Measures (eCQMs), MIPS Clinical Quality Measures (CQMs), Qualified Clinical Data Registry (QCDR) Measures, Medicare Part B claims measures, CMS Web Interface measures and The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey.
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Promoting Interoperability Score: 82
The Interoperability category measures the providers ability to use technology to exchange and make use of healthcare information in a way that is less burdensome and improves outcomes. The Interoperability measure category compromises 25% providers final MPIS scores.
The MIPS Interoperability measure focuses on the use of certified electronic health record technology (CEHRT) to improve patient access health information, the exchange of information between clinicians and pharmacies and the systematic collection, analysis, and interpretation of healthcare data. -
Improvement Activities Score: 40
The Improvement Activities performance category evaluates the providers participation in clinical activities that support the improvement of clinical practice, care delivery, and outcomes. Providers have the option to choose 2 to 4 activities from an inventory of over 100 improvement activities. Providers typically choose the activities that best fit their needs. The improvement activities measure category compromises 15% providers final MPIS scores.
The Improvement measures aim to better patient engagement, patient safety and other areas of patient care. The Improvement Activities category compromises 15% of providers final MPIS scores. -
Cost Score: N/A
The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.
Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores. -
Cost Score: N/A
The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.
Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.
Quality Reporting
The following quality measures meet Medicare's statistical reporting standards for the year 2018. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Breast Cancer Screening | 1% | 78 |
| Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer | ||
| Diabetes screening | Yes | N/A |
| Diabetes screening for people with schizophrenia or bipolar disease who are using antipsychotic medication. | ||
| Diabetes: Medical Attention for Nephropathy | 30% | 86 |
| The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period | ||
| Documentation of Current Medications in the Medical Record | 94% | 331 |
| 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. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration | ||
| Engagement of patients through implementation of improvements in patient portal | Yes | N/A |
| Access to an enhanced patient portal that provides up to date information related to relevant chronic disease health or blood pressure control, and includes interactive features allowing patients to enter health information and/or enables bidirectional communication about medication changes and adherence. | ||
| e-Prescribing | 100% | 2971 |
| At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology. | ||
| Pneumococcal Vaccination Status for Older Adults | 4% | 142 |
| Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine | ||
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | 99% | 331 |
| Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2 | ||
| Preventive Care and Screening: Influenza Immunization | 49% | 323 |
| 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 | ||
| Provide Patient Access | 75% | 750 |
| 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 certain information. | ||
| Security Risk Analysis | Yes | N/A |
| Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process. | ||
| Tobacco use | Yes | N/A |
| Tobacco use: Regular engagement of MIPS eligible clinicians or groups in integrated prevention and treatment interventions, including tobacco use screening and cessation interventions (refer to NQF #0028) for patients with co-occurring conditions of behavioral or mental health and at risk factors for tobacco dependence. | ||
| Use of High-Risk Medications in the Elderly | 93% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better. | 130 |
| Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication. 2) Percentage of patients who were ordered at least two of the same high-risk medication | ||
Clinician Services
The following Healthcare Common Procedure Coding System (HCPCS) codes were publicly reported as the top services rendered by this provider under the Medicare program for the year 2020. The reported codes are based on the top 5 codes for each available specialty, excluding evaluation and management codes.
- 92
Administration of influenza virus vaccine (HCPCS:G0008)
- 29
Injection beneath the skin or into muscle for therapy, diagnosis, or prevention (HCPCS:96372)
Hospital Affiliations
Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Samir Patel is affiliated with the following medical facilities:
| Hospital Name | Address | Phone | Hospital Type | Overall Rating |
|---|---|---|---|---|
| RARITAN BAY MEDICAL CENTER | 530 NEW BRUNSWICK AVE PERTH AMBOY, NJ 8861 | (732) 324-5000 | Acute Care Hospitals | |
| SAINT BARNABAS MEDICAL CENTER | 94 OLD SHORT HILLS ROAD LIVINGSTON, NJ 7039 | (973) 322-5000 | Acute Care Hospitals | |
| JFK MEDICAL CENTER | 65 JAMES STREET EDISON, NJ 8820 | (732) 321-7000 | Acute Care Hospitals |
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 5 | 8 | 8 | 6 | 5 | 9 | 2 | 9 | 6 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 5 | 16 | 8 | 12 | 5 | 18 | 2 | 18 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 5 + 1 + 6 + 8 + 1 + 2 + 5 + 1 + 8 + 2 + 1 + 8 + 24 = 74 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 80 - 74 = 6 | 6 | ||||||||
The NPI number 1588659296 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following provider is registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1134225162 | DEEPA SAMIR PATEL M.D. Individual | Internal Medicine | 407 MAIN ST STE 1 SPOTSWOOD, NJ 08884 (732) 416-0065 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1588659296, enumerated in the NPI registry as an "individual" on September 19, 2005
The provider is located at 407 Main St Ste 1 Spotswood, Nj 08884 and the phone number is (732) 416-0065
The provider's speciality is Internal Medicine with taxonomy code 207R00000X
The provider has more than 34 years of experience.
The provider might be accepting Accepts: Ambetter Health of Delaware, Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of May 10, 2024 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
The provider has an overall high rating in the following quality measures: quality clinical practices and patient outcomes and experiences , uses technology to exchange and make use of healthcare information.
Medicare beneficiaries should expect a typical cost of $150.56 with an average copayment of $37.64 for new patient appointments. Established patients should expect a typical charge of $116.86 and an average copayment of 29.21. Please review your insurance plan or contact the provider directly to determine your specific costs.
The most common procedures or services performed by this practitioner are: Administration of influenza virus vaccine and Injection beneath the skin or into muscle for therapy, diagnosis, or prevention.
The practitioner is affiliated to the following hospital(s): RARITAN BAY MEDICAL CENTER, SAINT BARNABAS MEDICAL CENTER and JFK MEDICAL CENTER. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.
This NPI record was last updated on September 19, 2005. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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