2026 NPPES data Pediatric Orthopaedic Surgery Physician NPI 1699290775 MD
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ASHISHKUMAR PATEL, MD

Pediatric Orthopaedic Surgery Physician in DU BOIS, Pennsylvania. CMS National Plan and Provider Enumeration System profile including specialty classification, practice address, and Medicare prescribing data when reported.

Federal data — no proprietary rating. PlainDoctor publishes the actual CMS NPPES and Medicare records — NPI registration, specialty, practice location, and prescribing data — without a composite score or editorial opinion on top. Every field traces to a federal source.
Prescribing volume
253
Medicare Part D claims · 82 beneficiaries · Pediatric Orthopaedic Surgery Physician avg: 128
MIPS score
96.566/100
▲ 13 pts above national avg 83.1 · [object Object]
Industry payments
$35.41
2 payments · CMS Open Payments (Sunshine Act)

What the federal data shows

ASHISHKUMAR PATEL, MD reported a CMS MIPS final score of 96.566/100 — above the 83.1 national average — and filed 253 Medicare Part D claims in 2023.

96.566/100
MIPS score · +13 vs avg
253
Part D claims, 2023
Likely
board-certified (heuristic)

Every figure on this page comes straight from federal CMS records (NPPES, Medicare Part D, MIPS, Open Payments) — no proprietary rating or editorial opinion is applied.

ASHISHKUMAR PATEL, MD's MIPS score vs every scored U.S. clinician

CMS Merit-based Incentive Payment System (MIPS) final score, 2023 — the federal quality measure

97 Top 17% higher than 83% of 477,587 scored providers

0–10: 8,684 scored providers (2%). Below this entry. 10–20: 3,008 scored providers (1%). Below this entry. 20–30: 3,069 scored providers (1%). Below this entry. 30–40: 2,746 scored providers (1%). Below this entry. 40–50: 2,928 scored providers (1%). Below this entry. 50–60: 5,882 scored providers (1%). Below this entry. 60–70: 13,906 scored providers (3%). Below this entry. 70–80: 118,074 scored providers (25%). Below this entry. 80–90: 129,887 scored providers (27%). Below this entry. 90–100: 189,403 scored providers (40%). This entry sits in this band. This provider 0 100 every MIPS-scored clinician, bucketed by value

Each bar is a band; taller bars hold more scored providers. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.

Source CMS Merit-based Incentive Payment System (MIPS) · 2023

Board certification likely (heuristic — not verified)

ASHISHKUMAR PATEL, MD practices in an ABMS-board-eligible specialty and shows active CMS Medicare participation + MIPS quality reporting + 2 hospital affiliations — signals consistent with board-certified status. For verified board certification, see CertificationMatters.org (the official ABMS public lookup).

What does the federal data show about ASHISHKUMAR PATEL, MD?

High performer (top quartile)

NPI registry status

Active

Issued 08/09/2017

NPI 1699290775

Primary specialty

Pediatric Orthopaedic Surgery Physician

Niche

613 US NPIs in this specialty

Medicare Part D claims

253 98% vs specialty avg

2023 prescription claims

Specialty avg: 128

MIPS final score

96.566/100 13.466000000000008% pts

Exceptional band

vs 83.1 national avg

Specialty distribution in Pennsylvania

How Pediatric Orthopaedic Surgery Physician compares to other specialties among Pennsylvania providers

Pennsylvania providers

Pediatric Orthopaedic Surgery Physician share within Pennsylvania

1. Pediatric Orthopaedic Surgery Physician42%2. Internal medicine21%3. Family medicine17%4. Surgical12%5. Pediatric8%
Pediatric Orthopaedic Surgery Physician share within Pennsylvania

Medicare quality performance — MIPS

ASHISHKUMAR PATEL, MD's 2023 MIPS final score plotted against the Pediatric Orthopaedic Surgery Physician national average

High performer (top quartile)
MIPS Final Score
96.566/100
vs 83.1 national avg · 2023 performance year

MIPS final score (Pediatric Orthopaedic Surgery Physician) — 96.566/100 vs national avg 83.1

0%100%National avg83%96.6%
MIPS final score (Pediatric Orthopaedic Surgery Physician) — 96.566/100 vs national avg 83.1

The Merit-based Incentive Payment System (MIPS) scores providers 0–100 across four performance categories: Quality, Cost, Promoting Interoperability, and Improvement Activities, weighted under 42 CFR §414.1380. Reporting is voluntary for many small practices, so absence of a MIPS score is not a quality signal.

Board certification through an ABMS or AOA member board signals voluntary post-licensure examination plus continuous Maintenance of Certification cycles. Verify any individual provider's status through certificationmatters.org (ABMS) or osteopathic.org (AOA).

ASHISHKUMAR PATEL, MD appears in the CMS NPPES registry as a Pediatric Orthopaedic Surgery Physician provider holding MD credentials at 145 HOSPITAL AVE STE 311, DU BOIS, PA, 15801, with a listed phone of (814) 375-6200. NPI 1699290775 was issued on 08/09/2017. Because NPPES data is self-reported by the provider and refreshed monthly, the address, phone, and specialty reflect what PATEL most recently submitted to CMS rather than a vetted directory listing, which is why patients should always confirm the practice is still at this location before scheduling.

Medicare Part D records for calendar year 2023 show 253 prescription claims written by this provider, covering 82 Medicare beneficiaries and totaling roughly $7K in drug spend, with an opioid prescribing rate of 31.6%. These figures capture only Medicare Part D — commercial insurance, Medicaid, and cash-pay prescriptions are not included, and any drug-beneficiary cell under 11 is suppressed by CMS for patient privacy. On the CMS Merit-based Incentive Payment System, this provider earned a Final Score of 96.566/100 for the 2023 performance year, compared with the national average of 83.1.

Pediatric Orthopaedic Surgery Physician is a narrow specialty nationwide, with 613 enrolled providers across 49 states and an average of 128 Part D claims per prescriber, so the context for interpreting these metrics differs meaningfully from a primary-care baseline. Important: PlainDoctor is a directory of publicly available government data, not medical advice, a malpractice database, or a quality rating. Inclusion here does not imply a recommendation, and absence of complaints or sanctions on this page does not mean none exist — always verify credentials through the NPPES NPI Registry, your state medical board, and the ABMS or AOA before making healthcare decisions.

Practice Address

145 HOSPITAL AVE STE 311
DU BOIS, PA 15801

Provider Details

NPI 1699290775
Specialty Pediatric Orthopaedic Surgery Physician
Credentials MD
Gender Male
NPI Issued 08/09/2017

CMS Quality Score (MIPS)

Merit-based Incentive Payment System (MIPS) scores from CMS, 2023 performance year.

96.566
Final Score
Avg: 83.1
95.96
Promoting Interoperability

Reporting: Group practice

Hospital and facility affiliations

Facilities where ASHISHKUMAR PATEL, MD bills Medicare from. Star ratings (1-5) are CMS Hospital Compare's "Hospital overall rating" — a composite of mortality, readmission, patient experience, safety, timely care, and efficient use of medical imaging measures. Source: CMS Care Compare.

DUBOIS REGIONAL MEDICAL CENTER
DU BOIS, PA
PHOENIX REHABILITATION AND HEALTH SERVICES INC
CRANBERRY TOWNSHIP, PA

Affiliations sourced from CMS Doctors and Clinicians National Downloadable File; hospital ratings from CMS Hospital General Information dataset (cross-referenced by facility name + state).

Industry payments received (2024) — CMS Open Payments transparency data

The federal Physician Payments Sunshine Act (part of the Affordable Care Act) requires drug and medical-device manufacturers + group purchasing organizations to publicly report payments and other transfers of value to physicians and teaching hospitals. The data below covers 2024 for ASHISHKUMAR PATEL, MD. Source: openpaymentsdata.cms.gov.

Total received

$35

Largest payer

Smith+Nephew, Inc.

Most common payment type

Food and Beverage

Industry payments are not necessarily indicators of bias — they include research funding, consulting fees for evidence-based work, royalties for inventions, food at conferences, and similar items. The disclosure exists for transparency. Read our methodology for how we interpret this data.

License & disciplinary context — Pennsylvania PA-BOM 2023 annual report

Aggregate state board data only — NOT a determination of any individual provider's status. The figures below describe statewide disciplinary activity across all ~45K Pennsylvania medical licensees in 2023 — they are NOT specific to ASHISHKUMAR PATEL, MD. To verify ASHISHKUMAR PATEL, MD's current license status, search the PA-BOM public license lookup directly, or check the Federation of State Medical Boards (FSMB) verification service.

133
Total board actions, Pennsylvania 2023
Across 129 cases
2.96
Actions per 1,000 licensees
Pennsylvania statewide rate
probation
Most common action type
48 cases

PA-BOM publishes annual disciplinary statistics as part of public-record reporting under each state's Administrative Procedure Act. See the full breakdown by action type and year on the Pennsylvania disciplinary trends page. Cross-checked against FSMB U.S. Medical Regulatory Trends.

Medicare Part D Prescribing Data

CMS Medicare Part D prescriber-level data for calendar year 2023.

253
Total Claims
$7K
Total Drug Cost
82
Medicare Beneficiaries

Prescribing Breakdown

30-Day Fills
255
Total Day Supply
815
Generic Drug Cost
$867
Opioid Claims
80 (31.6% rate)
Antibiotic Claims
91

Patient Demographics

Average Patient Age
67.8 years
Avg HCC Risk Score
1.43
Gender Split
61% female / 39% male
Age Distribution
<65: 23, 65-74: 43, 75-84: N/A, 85+: N/A

Top Prescribed Drugs (Medicare Part D)

Top drugs by claim count for calendar year 2023. Based on Medicare Part D data only.

What ASHISHKUMAR PATEL, MD prescribes most

Top Medicare Part D drugs by claim count, 2023

claims
Source CMS Medicare Part D Prescriber Public Use File As of 2023
Drug Claims
Oxycodone Hcl
76
Cephalexin
73
Prochlorperazine Maleate
69
Clindamycin Hcl
15
Ondansetron Hcl
11

* Counts below 11 are suppressed by CMS for patient privacy. Generic names shown where available from CMS Part D data.

Pediatric Orthopaedic Surgery Physician Overview

How ASHISHKUMAR PATEL, MD fits within the Pediatric Orthopaedic Surgery Physician landscape nationally.

613
Pediatric Orthopaedic Surgery Physician Providers in US
49
States with Pediatric Orthopaedic Surgery Physician
128
Avg Claims per Provider

ASHISHKUMAR PATEL, MD's 253 claims are above the specialty average of 128.

Nearby Pediatric Orthopaedic Surgery Physician Providers in Pennsylvania

Other clinicians with the same primary specialty enrolled in Pennsylvania, drawn from the same CMS NPPES roster as PATEL.

Compare Pediatric Orthopaedic Surgery Physician nationally: see state-by-state distribution →

Frequently Asked Questions

What is ASHISHKUMAR PATEL, MD's specialty?
ASHISHKUMAR PATEL, MD specializes in Pediatric Orthopaedic Surgery Physician and practices in DU BOIS, Pennsylvania. Credentials: MD.
How much does ASHISHKUMAR PATEL, MD prescribe under Medicare Part D?
In 2023, ASHISHKUMAR PATEL, MD wrote 253 Medicare Part D claims totaling $7K in drug costs for 82 beneficiaries.
What is ASHISHKUMAR PATEL, MD's Medicare quality score?
ASHISHKUMAR PATEL, MD has a CMS MIPS Final Score of 96.566/100. The national average MIPS Final Score is 83.1. Source: CMS Merit-based Incentive Payment System (MIPS) 2023.
Where is ASHISHKUMAR PATEL, MD located?
ASHISHKUMAR PATEL, MD is located at 145 HOSPITAL AVE STE 311, DU BOIS, PA, 15801. Phone: (814) 375-6200.
What is ASHISHKUMAR PATEL, MD's NPI number?
ASHISHKUMAR PATEL, MD's National Provider Identifier (NPI) is 1699290775, issued on 08/09/2017.
Does ASHISHKUMAR PATEL, MD prescribe opioids?
Yes, ASHISHKUMAR PATEL, MD had 80 opioid claims in 2023 with an opioid prescribing rate of 31.6%.
How many Pediatric Orthopaedic Surgery Physician providers are there in the US?
There are 613 Pediatric Orthopaedic Surgery Physician providers across 49 states in the US. The average Pediatric Orthopaedic Surgery Physician provider writes 128 Medicare Part D claims per year.
What drugs does ASHISHKUMAR PATEL, MD prescribe most often?
Based on 2023 Medicare Part D data, ASHISHKUMAR PATEL, MD's most frequently prescribed drugs include Oxycodone Hcl, Cephalexin, Prochlorperazine Maleate. This reflects Medicare Part D prescriptions only and does not include commercial insurance or other payer types.
Does ASHISHKUMAR PATEL, MD accept Medicare?
ASHISHKUMAR PATEL, MD appears in CMS Medicare data with 253 Part D claims and 82 Medicare beneficiaries in 2023. Contact the provider's office directly to confirm current Medicare enrollment and accepted plans.
How can I verify ASHISHKUMAR PATEL, MD's credentials?
ASHISHKUMAR PATEL, MD's NPI is 1699290775 with credentials MD. You can verify this through the NPPES NPI Registry, check state medical board records, and confirm board certification through the ABMS or AOA.

Data Sources

Provider Directory
CMS National Plan and Provider Enumeration System (NPPES), download.cms.gov/nppes, updated monthly. Contains NPI, specialty, credentials, and practice location.
Specialty Classification
NUCC Health Care Provider Taxonomy (nucc.org), the industry standard for classifying provider specialties in Medicare and Medicaid billing.
Prescribing Data
CMS Medicare Part D Prescriber Public Use File (2023). Includes claims, drug costs, beneficiaries, and opioid prescribing rates.
Quality Performance
CMS Merit-based Incentive Payment System (MIPS) — 2023 performance year.
Limitations
Provider data is self-reported to CMS. Prescribing data reflects Medicare Part D only and does not include commercial insurance, Medicaid, or cash prescriptions. Claims below 11 beneficiaries are suppressed by CMS for privacy.

See our complete data methodology for details on how we collect and process government data.

Data as of April 2026 (NPPES) / 2023 (Medicare Part D). Source: Centers for Medicare & Medicaid Services (CMS).

Disclaimer: Data from CMS NPPES and Medicare Part D. PlainDoctor does not rate or rank providers. Provider information is self-reported and may not be current. Always verify information directly with the provider. About · Methodology