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MR. SANJAYA KUMAR SWAIN M.D
NPI 1780023135
Urology in Miami, FL

Active since June 19, 2013PECOS EnrolledAccepts Medicare Assignment
81.31/100
CMS Quality Rating
1150 PAC CLINIC UNIVERSITY OF MIAMI HOSPITAL, ROOM NO 309, MIAMI, FL 33136(305) 243-7217(305) 243-2919 Get Directions Write a Review

NPPES record last updated: November 13, 2015. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Oct 12, 2023, Nov 13, 2015 (2 updates tracked since 2015).

About Mr. Sanjaya Kumar Swain M.d NPPES

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

MR. SANJAYA KUMAR SWAIN M.D (NPI 1780023135) is an individual urology provider in Miami, Florida, licensed in Florida (MFC1746) and active in the NPI registry since June 2013. He is enrolled in Medicare PECOS, is affiliated with Jackson Health System, and is a graduate of Other (1992).

NPPES Registry Identity

NPI1780023135
Entity TypeIndividualMale
Primary Taxonomy208800000X
Provider Legal NameMR. SANJAYA KUMAR SWAINCredential: M.D
Location Address1150 PAC CLINIC UNIVERSITY OF MIAMI HOSPITAL, ROOM NO 309Miami, FL 33136
Mailing Address1120 Nw 14th Street Suite 1560, Clinical Research Building, Department Of UrologyMiami, FL 33136 · (305) 243-3670
Phone(305) 243-7217
Fax(305) 243-2919
Sole ProprietorNo
Medical School CMSOtherGraduated 1992
Enumeration DateJune 19, 2013
Last NPPES UpdateNovember 13, 20152 updates tracked since enumeration
✔ NPI 1780023135 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyUrologyAllopathic & Osteopathic Physicians
Taxonomy Code208800000X
License✔ Licensed in FL · MFC1746
Definition
A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X · License TRN18548 (FL)
1150 PAC CLINIC UNIVERSITY OF MIAMI HOSPITAL, Miami, FL 33136
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter of Alabama, AmeriHealth Caritas Next and more.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

Mr. Sanjaya Kumar Swain 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 ID3173825262
PECOS Enrollment IDI20160106001866
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 Reassignment

Medicare enrollment records show Sanjaya Swain reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

University Of Miami
Same address
Clinical Cardiac Electrophysiology
1295 NW 14TH ST, SUITE A
Miami, FL 33125
  • Reassigned Medicare billing, Florida enrollment
  • 3,639 clinicians in this Medicare group
NPI 1104232578 (305) 243-5554

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 7

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.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
68 services56 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.
26 services19 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.
22 services21 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
21 services11 patients
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203
This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
20 services20 patients
Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes 99221
Initial hospital inpatient care refers to the first day of your stay in the hospital. This service typically includes a 30-minute check-up with a healthcare professional. They'll assess your health, discuss your condition, and plan your treatment. It's part of ensuring you receive the best possible care.
16 services16 patients

Hospital Affiliations CMS Care Compare

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

Jackson Health System

Acute Care Hospitals · Miami, FL
1/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number100022
Location1611 NW 12th AveMiami, FL 33136 · Miami-Dade County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 33136 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
$141.56 typical visit price
range $60.92 – $187.05
Typical copayment $35.39 (range $15.23 – $46.76)
Most-billed visit code 99204
Established Patient
$75.86 typical visit price
range $18.99 – $150.24
Typical copayment $18.96 (range $4.74 – $37.56)
Most-billed visit code 99213
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.

81.31/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality78.45
Promoting Interoperability100
Improvement Activities40
Cost50.59

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 Sanjaya Swain's NPI number?

The NPI number for Sanjaya Swain is 1780023135. It was assigned to this individual provider in the NPPES registry on June 19, 2013.

Where is Sanjaya Swain located?

Sanjaya Swain practices at 1150 Pac Clinic University Of Miami Hospital Room No 309, Miami, FL 33136. The listed phone number is (305) 243-7217.

What is Sanjaya Swain's specialty?

The primary specialty registered for this NPI is Urology with taxonomy code 208800000X.

Is Sanjaya Swain enrolled in Medicare?

Yes. Sanjaya Swain 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 organization bills Medicare for Sanjaya Swain's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Sanjaya Swain reassigns Medicare benefits to University Of Miami (Miami, FL). The 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 Sanjaya Swain's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Sanjaya Swain accept?

Health plans from Ambetter Health, Ambetter of Alabama, AmeriHealth Caritas Next, Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) and 3 other insurers list Sanjaya Swain 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 Sanjaya Swain affiliated with any hospitals?

According to CMS data, Sanjaya Swain is affiliated with Jackson Health System.

When was this NPI record last updated?

The NPPES record for Sanjaya Swain was last updated on November 13, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.