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DR. TIBOR CHARLES KOPJAS M.D.
NPI 1952332918
Internal Medicine in Maryville, IL

Active since July 06, 2006PECOS EnrolledAccepts Medicare AssignmentCLIA 14D0721806 · Waiver
74.42/100
CMS Quality Rating
6812 STATE ROUTE 162 STE 209, MARYVILLE, IL 62062(618) 391-5061(618) 205-3923 Get Directions Write a Review

NPPES record last updated: August 28, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Mar 23, 2020, Feb 20, 2020 (2 updates tracked since 2020).

About Dr. Tibor Charles Kopjas M.d. NPPES

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

DR. TIBOR CHARLES KOPJAS M.D. (NPI 1952332918) is an individual internal medicine provider in Maryville, Illinois, licensed in Illinois (036070084) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS, holds a CLIA Waiver certificate valid through August 31, 2026, and is affiliated with Memorial Hospital.

NPPES Registry Identity

NPI1952332918
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameDR. TIBOR CHARLES KOPJASCredential: M.D.
Location Address6812 STATE ROUTE 162 STE 209Maryville, IL 62062-8562
Mailing Address6810 State Route 162 Box 215Maryville, IL 62062-8501 · (618) 391-6405 · Fax (618) 288-4088
Phone(618) 391-5061
Fax(618) 205-3923
Sole ProprietorNo
Medical School CMSUniversity Of Missouri, Columbia School Of MedicineGraduated 1983
Enumeration DateJuly 6, 2006
Last NPPES UpdateAugust 28, 20242 updates tracked since enumeration
NPPES CertifiedAugust 28, 2024
✔ NPI 1952332918 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in IL · 036070084
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.
6812 STATE ROUTE 162 STE 209, Maryville, IL 62062
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Secondary Practice Location 1

Location 12118 Vadalabene DrMaryville, IL 62062-5632 · Phone (618) 288-7081 · Fax (618) 288-6857

Other Identifiers 6

Other06000515IL · Blue Cross
Other166459IL · Ghp
Other100767IL · Healthlink
Other110016002IL · Rialroad Medicare
Medicaid036070084IL
Other0407247IL · United Health

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, 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. Tibor Charles Kopjas 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 ID5698863975
PECOS Enrollment IDI20071120000554
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.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D0721806

Tibor C Kopjas MD · Maryville, IL
Active · expires Aug 31, 2026
CLIA Number14D0721806
Laboratory TypePhysician Office
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorTibor C. Kopjas
Laboratory Phone(618) 391-5061
Laboratory LocationTibor C Kopjas MD6812 State Route 162 - Ste 209, Maryville, IL 62062
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 4

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.
397 services215 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.
137 services137 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.
111 services72 patients
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212
This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.
106 services74 patients

Hospital Affiliations CMS Care Compare 5

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

Memorial Hospital

Acute Care Hospitals · Belleville, IL
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140185
Location4500 Memorial DriveBelleville, IL 62226 · St. Clair County
Emergency services Birthing friendly

Hshs St Elizabeth's Hospital

Acute Care Hospitals · O Fallon, IL
4/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number140187
LocationOne St Elizabeth BoulevardO Fallon, IL 62269 · St. Clair County
Emergency services Birthing friendly

Anderson Hospital

Acute Care Hospitals · Maryville, IL
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140289
Location6800 State Route 162Maryville, IL 62062 · Madison County
Emergency services Birthing friendly

Community Hospital Of Staunton

Critical Access Hospitals · Staunton, IL
OwnershipVoluntary non-profit - Private
CMS Certification Number141306
Location400 N Caldwell StStaunton, IL 62088 · Macoupin County
Emergency services

St Joseph's Hospital

Critical Access Hospitals · Highland, IL
3/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number141336
Location12866 Troxler AvenueHighland, IL 62249 · Madison County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 62062 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
$131.14 typical visit price
range $56.28 – $173.35
Typical copayment $32.78 (range $14.07 – $43.33)
Most-billed visit code 99204
Established Patient
$99.71 typical visit price
range $17.51 – $139.99
Typical copayment $24.92 (range $4.37 – $34.99)
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.

74.42/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality70.31
Promoting Interoperability85
Improvement Activities40
Cost56.92

Referred Medical Equipment & Supplies CMS DME claims 17

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
16 suppliers55 claims118 services$6.03 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
7 suppliers20 claims21 services$0.97 avg. paid by Medicare
Tubing with integrated heating element for use with positive airway pressure device A4604
DME-Other DME · category DE001N
5 suppliers26 claims26 services$31.86 avg. paid by Medicare
Full face mask used with positive airway pressure device, each A7030
DME-Other DME · category DE001N
8 suppliers30 claims30 services$78.76 avg. paid by Medicare
Face mask interface, replacement for full face mask, each A7031
DME-Other DME · category DE001N
8 suppliers31 claims77 services$30.49 avg. paid by Medicare
Cushion for use on nasal mask interface, replacement only, each A7032
DME-Other DME · category DE001N
4 suppliers21 claims101 services$14.26 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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 Tibor Kopjas's NPI number?

The NPI number for Tibor Kopjas is 1952332918. It was assigned to this individual provider in the NPPES registry on July 6, 2006.

Where is Tibor Kopjas located?

Tibor Kopjas practices at 6812 State Route 162 Ste 209, Maryville, IL 62062. The listed phone number is (618) 391-5061.

What is Tibor Kopjas's specialty?

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

Is Tibor Kopjas enrolled in Medicare?

Yes. Tibor Kopjas 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.

Does Tibor Kopjas hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D0721806) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Tibor Kopjas accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Ambetter from Home State Health list Tibor Kopjas 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 Tibor Kopjas affiliated with any hospitals?

According to CMS data, Tibor Kopjas is affiliated with Memorial Hospital, Hshs St Elizabeth's Hospital, Anderson Hospital, Community Hospital Of Staunton and St Joseph's Hospital.

When was this NPI record last updated?

The NPPES record for Tibor Kopjas was last updated on August 28, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.