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AJAY KOIRALA M.D.
NPI 1730532656
Internal Medicine in Lewes, DE

Active since July 15, 2016PECOS EnrolledAccepts Medicare Assignment
81.19/100
CMS Quality Rating
424 SAVANNAH RD, LEWES, DE 19958(302) 645-3525(302) 645-3513 Get Directions Write a Review

NPPES record last updated: April 24, 2025. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Ajay Koirala M.d. NPPES

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

AJAY KOIRALA M.D. (NPI 1730532656) is an individual internal medicine provider in Lewes, Delaware, licensed in Delaware (C1-0027902) and active in the NPI registry since July 2016. He is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2011).

NPPES Registry Identity

NPI1730532656
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameAJAY KOIRALACredential: M.D.
Location Address424 SAVANNAH RDLewes, DE 19958-1462
Mailing Address1515 Savannah RdLewes, DE 19958-1675 · (302) 645-3499 · Fax (302) 644-4830
Phone(302) 645-3525
Fax(302) 645-3513
Sole ProprietorNo
Medical School CMSOtherGraduated 2011
Enumeration DateJuly 15, 2016
Last NPPES UpdateApril 24, 2025
NPPES CertifiedApril 24, 2025
✔ NPI 1730532656 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Licenses✔ Licensed in DE · C1-0027902✔ Licensed in PA · MT211346
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.
424 SAVANNAH RD, Lewes, DE 19958
Open in Google Maps ↗

Secondary Practice Locations 2

Location 1420 S 5th AveWest Reading, PA 19611-2143 · Phone (484) 628-8640 · Fax (484) 628-9003
Location 21305 Savannah RdLewes, DE 19958-1501 · Phone (302) 291-6450 · Fax (866) 436-6114

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include AmeriHealth Caritas Next, Highmark Blue Cross Blue Shield 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

Ajay Koirala 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 ID3173816022
PECOS Enrollment IDI20250627000031
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 3

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.

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.
102 services102 patients
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
65 services65 patients
Critical care, first 30-74 minutes 99291
Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.
41 services40 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19958 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
$131.15 typical visit price
range $57.12 – $173.08
Typical copayment $32.78 (range $14.28 – $43.27)
Most-billed visit code 99204
Established Patient
$100.68 typical visit price
range $18.36 – $141.05
Typical copayment $25.17 (range $4.59 – $35.26)
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.

81.19/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality74.56
Promoting Interoperability97
Improvement Activities40
Cost65.23

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.

TYLENE LAW RN
Registered Nurse (Critical Care Medicine)
424 SAVANNAH RD
LEWES, DE 19958
Sussex County (302) 645-3300
MR. DEREK ECKENRODE
Registered Nurse
424 SAVANNAH RD
LEWES, DE 19958
Sussex County (302) 645-3300
MRS. AMY GILBERT R.N.
Registered Nurse (Critical Care Medicine)
424 SAVANNAH RD
LEWES, DE 19958
Sussex County (302) 645-3300
CHELSEY WEBB
Registered Nurse
424 SAVANNAH RD
LEWES, DE 19958
Sussex County (302) 258-6833
MR. EDWARD MORRIS RN, BSN, CRNFA
Registered Nurse
424 SAVANNAH RD
LEWES, DE 19958
Sussex County (302) 645-3316
DEBORAH KATALENAS RN
Registered Nurse
424 SAVANNAH RD, BEEBE HEALTH CARE
LEWES, DE 19958
Sussex County (302) 645-3300
MR. JUSTIN ROSS SPENCER
Registered Nurse
424 SAVANNAH RD
LEWES, DE 19958
Sussex County (302) 645-3336
MS. BRITTANY KAITLYN LASKEY RN, BSN
Registered Nurse
424 SAVANNAH RD
LEWES, DE 19958
Sussex County (302) 645-3300

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 Koirala's NPI number?

The NPI number for Ajay Koirala is 1730532656. It was assigned to this individual provider in the NPPES registry on July 15, 2016.

Where is Ajay Koirala located?

Ajay Koirala practices at 424 Savannah Rd, Lewes, DE 19958. The listed phone number is (302) 645-3525.

What is Ajay Koirala's specialty?

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

Is Ajay Koirala enrolled in Medicare?

Yes. Ajay Koirala 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.

What insurance does Ajay Koirala accept?

Health plans from AmeriHealth Caritas Next and Highmark Blue Cross Blue Shield Delaware list Ajay Koirala 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 Koirala was last updated on April 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.