DR. THEOPHANIS A PAVLOU MD
NPI 1871552026
Internal Medicine - Pulmonary Disease in Englewood, NJ
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
Specialties & Licenses
Other Identifiers 3
Accepted 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
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.
Medicare Billing Reassignment
Medicare enrollment records show Theophanis Pavlou reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Teaneck, NJ 07666
- Reassigned Medicare billing, New Jersey enrollment
- 23 clinicians in this Medicare group
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 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.
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, NJHoly Name Medical Center
Acute Care Hospitals · Teaneck, NJEnglewood Hospital And Medical Center
Acute Care Hospitals · Englewood, NJPhysician 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.
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
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.
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.
ENGLEWOOD, NJ 07631
ENGLEWOOD, NJ 07631
ENGLEWOOD, NJ 07631
ENGLEWOOD, NJ 07631
ENGLEWOOD, NJ 07631
ENGLEWOOD, NJ 07631
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.
Which organization bills Medicare for Theophanis Pavlou's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Theophanis Pavlou reassigns Medicare benefits to Holy Name Pulmonary Associates, PC (Teaneck, NJ). 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 Theophanis Pavlou's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
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.