DR. THEOPHANIS A PAVLOU MD
NPI 1871552026
Internal Medicine - Pulmonary Disease in Englewood, NJ

Q: What is Theophanis Pavlou's NPI number?

The NPI number for Theophanis Pavlou is 1871552026. It was assigned to this individual provider in the NPPES registry on March 17, 2006.

Q: What is Theophanis Pavlou's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Pulmonary Disease, with taxonomy code 207RP1001X.

Q: When was this NPI record last updated?

The NPPES record for Theophanis Pavlou was last updated on November 7, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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 March 17, 2006PECOS EnrolledAccepts Medicare Assignment

200 GRAND AVE, SUITE 102, ENGLEWOOD, NJ 07631(201) 871-3636(201) 871-2286 Get Directions Write a Review

NPPES record last updated: November 7, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Dr. Theophanis A Pavlou Md NPPES

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

DR. THEOPHANIS A PAVLOU MD (NPI 1871552026) is an individual pulmonary disease provider in Englewood, New Jersey, licensed in New Jersey (MA59211) and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS, is affiliated with Palisades Medical Center, and is a graduate of New York Medical College (1987).

NPPES Registry Identity

NPI1871552026

Entity TypeIndividualMale

Primary Taxonomy207RP1001X

Provider Legal NameDR. THEOPHANIS A PAVLOUCredential: MD

Location Address200 GRAND AVE, SUITE 102Englewood, NJ 07631-4363

Mailing Address200 Grand Ave, Suite 102Englewood, NJ 07631-4363 · (201) 871-3636 · Fax (201) 871-2286

Phone(201) 871-3636

Fax(201) 871-2286

Sole ProprietorYes

Medical School CMSNew York Medical CollegeGraduated 1987

Enumeration DateMarch 17, 2006

Last NPPES UpdateNovember 7, 2011

✔ NPI 1871552026 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Pulmonary DiseaseAllopathic & Osteopathic Physicians

Taxonomy Code207RP1001X

License✔ Licensed in NJ · MA59211

Definition

An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.

200 GRAND AVE, Englewood, NJ 07631

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Other Identifiers 3

Medicaid6341705NJ

Medicare UPINF52956

Medicare ID-Type Unspecified736817BFB

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of 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

Dr. Theophanis A Pavlou 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 ID143375279

PECOS Enrollment IDI20090826000099

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 25

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 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.

460 services312 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.

386 services201 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.

161 services110 patients

Insertion of needle into vein for collection of blood sample 36415

This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.

159 services92 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.

100 services73 patients

X-ray of chest, 2 views 71046

A chest X-ray, 2 views, is a quick, painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. Two different angles are used to get a comprehensive view. This helps in diagnosing conditions like pneumonia, heart problems, or lung cancer.

91 services79 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.

77 services76 patients

Test to measure expiratory airflow and volume changes before and after medication administration 94060

This procedure measures how air flows in and out of your lungs. It's done before and after medication to see if the treatment improves your breathing. It's a simple, non-invasive test that involves breathing into a device called a spirometer.

68 services62 patients

Sleep study in sleep lab (6 years or older) 95810

A sleep study in a sleep lab is a non-invasive overnight test that monitors your body while you sleep. It helps doctors understand your sleep patterns and identify any issues like sleep apnea or insomnia. You'll be connected to equipment that tracks your heart rate, brain waves, breathing, and movements.

56 services55 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

56 services56 patients

Test to determine lung volumes using gas dilution or washout 94727

This test measures lung volumes by either diluting or washing out a known amount of gas in your lungs. You'll breathe in a harmless gas, then exhale. The exhaled air is analyzed to assess your lung capacity and function.

55 services54 patients

Test to examine how well the lungs exchange gases 94729

This is a test called a pulmonary function test, which helps understand the efficiency of your lungs. It measures how much air your lungs can hold, how quickly you can move air in and out of your lungs, and how well your lungs put oxygen into and remove carbon dioxide from your blood.

55 services54 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.

52 services52 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.

48 services29 patients

Urinalysis, manual test 81002

A urinalysis is a simple, non-invasive test that checks the urine for various elements such as sugar, protein, and signs of infection. It can help detect many common conditions, including kidney disease and diabetes. The manual test involves a lab technician examining a urine sample.

43 services42 patients

Sleep study in sleep lab with continuous airway pressure (6 years or older) 95811

A sleep study in a sleep lab with continuous airway pressure is a test for individuals aged 6 and above. It monitors your sleep patterns to check for disorders like sleep apnea. Continuous airway pressure helps keep your airways open while you sleep, improving your breathing.

40 services40 patients

Administration of influenza virus vaccine G0008

The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.

37 services37 patients

Influenza vaccine, inactivated 90653

The Influenza vaccine, inactivated, is a shot given to protect against the flu. It contains killed virus particles that help your body build immunity to the flu. It's recommended annually to keep your protection up-to-date. It's safe for ages 6 months and up.

36 services36 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

36 services36 patients

Sleep study including heart rate, breathing, airflow, and effort 95806

A sleep study monitors your heart rate, breathing patterns, airflow, and physical effort while you sleep. It helps identify sleep disorders by tracking your sleep stages and cycles. This data aids doctors in diagnosing and treating sleep-related issues.

26 services26 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.

20 services20 patients

Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report 93000

An electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.

16 services15 patients

Sleep study including heart rate, breathing, and sleep time 95800

A sleep study monitors your sleep patterns to evaluate your sleep quality. It records your heart rate, breathing, and actual sleep time. This information helps identify any sleep disorders, ensuring you get the rest you need for optimal health.

15 services15 patients

Hospital discharge day management, 30 minutes or less 99238

Hospital discharge day management of 30 minutes or less includes finalizing your treatment, discussing your progress, and planning after-care at home. It ensures you're ready to leave the hospital and continue recovery safely.

11 services11 patients

Annual depression screening, 5 to 15 minutes G0444

An annual depression screening is a short, routine evaluation to check for signs of depression. It involves answering a series of questions about your feelings, thoughts, and behaviors. The process takes about 15 minutes and helps detect depression early for better management.

11 services11 patients

Hospital Affiliations CMS Care Compare 3

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

Palisades Medical Center

Acute Care Hospitals · North Bergen, NJ

2/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number310003

Location7600 River RdNorth Bergen, NJ 07047 · Hudson County

Emergency services Birthing friendly

Holy Name Medical Center

Acute Care Hospitals · Teaneck, NJ

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number310008

Location718 Teaneck RdTeaneck, NJ 07666 · Bergen County

Emergency services Birthing friendly

Englewood Hospital And Medical Center

Acute Care Hospitals · Englewood, NJ

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number310045

Location350 Engle StEnglewood, NJ 07631 · Bergen County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 07631 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

$144.86 typical visit price

range $63.84 – $190.92

Typical copayment $36.21 (range $15.96 – $47.73)

Most-billed visit code 99204

Established Patient

$111.57 typical visit price

range $20.97 – $155.92

Typical copayment $27.89 (range $5.24 – $38.98)

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.

Reported Quality Measures

e-Prescribing

At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.

98%349 patients4/55-star benchmark: 100%

Medication Reconciliation

The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.

78%89 patients3/55-star benchmark: 100%

Patient-Specific Education

The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.

48%353 patients2/55-star benchmark: 99%

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

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…

100%356 patients5/55-star benchmark: 100%

Provide Patient Access

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…

48%353 patients2/55-star benchmark: 100%

Secure Messaging

For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…

0%353 patients1/55-star benchmark: 59%

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 31

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

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253

DME-Other DME · category DE017N

8 suppliers19 claims53 services$5.65 avg. paid by Medicare

Tubing with integrated heating element for use with positive airway pressure device A4604

DME-Other DME · category DE001N

21 suppliers425 claims425 services$31.37 avg. paid by Medicare

Full face mask used with positive airway pressure device, each A7030

DME-Other DME · category DE001N

13 suppliers157 claims157 services$69.99 avg. paid by Medicare

Face mask interface, replacement for full face mask, each A7031

DME-Other DME · category DE001N

13 suppliers131 claims346 services$27.44 avg. paid by Medicare

Cushion for use on nasal mask interface, replacement only, each A7032

DME-Other DME · category DE001N

14 suppliers150 claims850 services$14.68 avg. paid by Medicare

Pillow for use on nasal cannula type interface, replacement only, pair A7033

DME-Other DME · category DE001N

14 suppliers155 claims873 services$11.81 avg. paid by Medicare

Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034

DME-Other DME · category DE001N

20 suppliers390 claims390 services$42.68 avg. paid by Medicare

Headgear used with positive airway pressure device A7035

DME-Other DME · category DE001N

23 suppliers302 claims302 services$14.21 avg. paid by Medicare

Chinstrap used with positive airway pressure device A7036

DME-Other DME · category DE001N

11 suppliers35 claims35 services$8.73 avg. paid by Medicare

Tubing used with positive airway pressure device A7037

DME-Other DME · category DE001N

12 suppliers94 claims94 services$10.07 avg. paid by Medicare

Filter, disposable, used with positive airway pressure device A7038

DME-Other DME · category DE001N

24 suppliers489 claims2,673 services$1.64 avg. paid by Medicare

Filter, non disposable, used with positive airway pressure device A7039

DME-Other DME · category DE001N

14 suppliers120 claims120 services$4.92 avg. paid by Medicare

Exhalation port with or without swivel used with accessories for positive airway devices, replacement only A7045

DME-Other DME · category DE001N

2 suppliers29 claims29 services$9.39 avg. paid by Medicare

Water chamber for humidifier, used with positive airway pressure device, replacement, each A7046

DME-Other DME · category DE001N

18 suppliers188 claims188 services$9.95 avg. paid by Medicare

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431

DME-Oxygen and Supplies · category DC000N

4 suppliers49 claims50 services$13.41 avg. paid by Medicare

Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) E0466

DME-Other DME · category DE005N

2 suppliers13 claims13 services$909.12 avg. paid by Medicare

Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) E0471

DME-Other DME · category DE001N

3 suppliers40 claims40 services$162.98 avg. paid by Medicare

High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each E0483

DME-Other DME · category DE000N

2 suppliers31 claims31 services$819.68 avg. paid by Medicare

Humidifier, heated, used with positive airway pressure device E0562

DME-Other DME · category DE001N

12 suppliers57 claims57 services$112.06 avg. paid by Medicare

Humidifier, heated, used with positive airway pressure device E0562

DME-Other DME · category DE001N

6 suppliers92 claims92 services$10.60 avg. paid by Medicare

Nebulizer, with compressor E0570

DME-Other DME · category DE000N

3 suppliers25 claims25 services$4.61 avg. paid by Medicare

Continuous positive airway pressure (cpap) device E0601

DME-Other DME · category DE001N

17 suppliers593 claims598 services$25.96 avg. paid by Medicare

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

7 suppliers197 claims198 services$60.24 avg. paid by Medicare

Portable oxygen concentrator, rental E1392

DME-Oxygen and Supplies · category DC002N

3 suppliers44 claims44 services$30.36 avg. paid by Medicare

Formoterol fumarate, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 20 micrograms J7606

DME-Drugs Administered Through DME · category DG006N

2 suppliers30 claims1,800 services$6.41 avg. paid by Medicare

Acetylcysteine, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per gram J7608

DME-Drugs Administered Through DME · category DG000N

1 supplier11 claims264 services$4.61 avg. paid by Medicare

Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg J7613

DME-Drugs Administered Through DME · category DG006N

10 suppliers20 claims4,783 services$0.03 avg. paid by Medicare

Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg J7626

DME-Drugs Administered Through DME · category DG000N

4 suppliers47 claims3,000 services$0.80 avg. paid by Medicare

Revefenacin inhalation solution, fda-approved final product, non-compounded, administered through dme, 1 microgram J7677

DME-Drugs Administered Through DME · category DG006N

1 supplier27 claims141,750 services$0.15 avg. paid by Medicare

Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing K0738

DME-Oxygen and Supplies · category DC000N

3 suppliers42 claims42 services$27.46 avg. paid by Medicare

Pharmacy dispensing fee for inhalation drug(s); per 30 days Q0513

DME-Other DME · category DE000N

8 suppliers63 claims63 services$24.87 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PATRICIA K JOSEPH MD PC

Surgery

200 GRAND AVE, SUITE 202
ENGLEWOOD, NJ 07631

Bergen County (201) 567-5111

NORTH JERSEY INFECTIOUS DISEASE GROUP LLC

Internal Medicine (Infectious Disease)

200 GRAND AVE, SUITE 102
ENGLEWOOD, NJ 07631

Bergen County (201) 503-0660

DR. ROBIN MOTZ M.D.

Internal Medicine

200 GRAND AVE
ENGLEWOOD, NJ 07631

Bergen County (201) 569-0040

PULMONARY ASSOCIATES OF NORTHERN NEW JERSEY P A

Internal Medicine (Pulmonary Disease)

200 GRAND AVE, SUITE 102
ENGLEWOOD, NJ 07631

Bergen County (201) 871-3636

DR. SELWYN E LEVINE MD

Internal Medicine (Pulmonary Disease)

200 GRAND AVE, SUITE 102
ENGLEWOOD, NJ 07631

Bergen County (201) 871-3636

MR. VICTOR GORLOFF MD

Internal Medicine (Pulmonary Disease)

200 GRAND AVE, STE 102
ENGLEWOOD, NJ 07631

Bergen County (201) 871-3636

DR. CHUN KYU LOWE M.D., PH.D.

Thoracic Surgery (Cardiothoracic Vascular Surgery)

200 GRAND AVE, SUITE 204
ENGLEWOOD, NJ 07631

Bergen County (201) 568-8411

DR. SURAJ KUMAR SAGGAR D.O.

Internal Medicine (Infectious Disease)

200 GRAND AVE, SUITE 102
ENGLEWOOD, NJ 07631

Bergen County (201) 503-0660

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 Theophanis Pavlou's NPI number?

The NPI number for Theophanis Pavlou is 1871552026. It was assigned to this individual provider in the NPPES registry on March 17, 2006.

Where is Theophanis Pavlou located?

Theophanis Pavlou practices at 200 Grand Ave Suite 102, Englewood, NJ 07631. The listed phone number is (201) 871-3636.

What is Theophanis Pavlou's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Pulmonary Disease, with taxonomy code 207RP1001X.

Is Theophanis Pavlou enrolled in Medicare?

Yes. Theophanis Pavlou 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 Theophanis Pavlou accept?

Health plans from Ambetter Health and Ambetter Health of Delaware list Theophanis Pavlou 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 Theophanis Pavlou affiliated with any hospitals?

According to CMS data, Theophanis Pavlou is affiliated with Palisades Medical Center, Holy Name Medical Center and Englewood Hospital And Medical Center.

When was this NPI record last updated?

The NPPES record for Theophanis Pavlou was last updated on November 7, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.