HETAL PATEL, M.D.
Pulmonary Disease Physician in EDISON, New Jersey. CMS National Plan and Provider Enumeration System profile including specialty classification, practice address, and Medicare prescribing data when reported.
What the federal data shows
HETAL PATEL, M.D. reported a CMS MIPS final score of 89.0079/100 — above the 83.1 national average — and filed 964 Medicare Part D claims in 2023.
- 89.0079/100
- MIPS score · +6 vs avg
- 964
- Part D claims, 2023
- 40%
- generic prescribing
- 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.
HETAL PATEL, M.D.'s MIPS score vs every scored U.S. clinician
CMS Merit-based Incentive Payment System (MIPS) final score, 2023 — the federal quality measure
89 Top 42% higher than 58% of 477,587 scored providers
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
HETAL PATEL, M.D. practices in an ABMS-board-eligible specialty and shows active CMS Medicare participation + MIPS quality reporting + 1 hospital affiliation — 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 HETAL PATEL, M.D.?
High performer (top quartile)Primary specialty
Medicare Part D claims
MIPS final score
Specialty distribution in New Jersey
How Pulmonary Disease Physician compares to other specialties among New Jersey providers
Pulmonary Disease Physician share within New Jersey
Pulmonary Disease Physician is one of the more visible NUCC categories in New Jersey
Each bar reflects the share of in-state providers whose primary NUCC taxonomy matches the specialty. Long tail of ~690 NUCC codes folded into "Other" to keep the comparison legible.
Medicare quality performance — MIPS
HETAL PATEL, M.D.'s 2023 MIPS final score plotted against the Pulmonary Disease Physician national average
- MIPS Final Score
- 89.0079/100
- vs 83.1 national avg · 2023 performance year
MIPS final score (Pulmonary Disease Physician) — 89.0079/100 vs national avg 83.1
Quality benchmarks
- National MIPS avg 2023 reporting year
- Quality dim CMS Quality category
- Cost dim CMS Cost category
- Specialty volume Pulmonary Disease Physician US NPIs
89.0079/100 MIPS final score — 5.9 pts above the 83.1 national average
Quality, Cost, Promoting Interoperability, and Improvement Activities composite score for the 2023 performance year. Specialty: Pulmonary Disease Physician. Quality dim: 72.4887. Cost dim: 85.5335.
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).
HETAL PATEL, M.D. appears in the CMS NPPES registry as a Pulmonary Disease Physician provider holding M.D. credentials at 34 SIMPSON AVE, EDISON, NJ, 08817, with a listed phone of (732) 572-0369. NPI 1801190962 was issued on 01/04/2011. 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 964 prescription claims written by this provider, covering 212 Medicare beneficiaries and totaling roughly $659K in drug spend, split 60% brand-name and 40% generic by claim count. 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 89.0079/100 for the 2023 performance year (Quality 72.4887, Cost 85.5335), compared with the national average of 83.1.
Pulmonary Disease Physician is a mid-sized specialty nationwide, with 9,271 enrolled providers across 53 states and an average of 1,457 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
Provider Details
| NPI | 1801190962 |
|---|---|
| Specialty | Pulmonary Disease Physician |
| Credentials | M.D. |
| Gender | Male |
| NPI Issued | 01/04/2011 |
Verify this provider's license
PlainDoctor pulls this profile from the CMS NPPES public registry. Confirm HETAL PATEL, M.D.'s current license status, disciplinary history, and board certifications with the New Jersey State Board of Medical Examiners in New Jersey before relying on this page for a clinical or care decision.
How we sourced this profile
CMS Quality Score (MIPS)
Merit-based Incentive Payment System (MIPS) scores from CMS, 2023 performance year.
Reporting: Group practice
Hospital and facility affiliations
Facilities where HETAL PATEL, M.D. 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.
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 HETAL PATEL, M.D.. Source: openpaymentsdata.cms.gov.
Total received
$4.3K
Largest payer
INTUITIVE SURGICAL, 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.
Brand vs generic prescribing mix · Brand-heavy
60% brand-name claims vs 40% generic, on 964 2023 Medicare Part D claims.
The federal Medicare Part D Generic Dispensing Rate national benchmark sits near 90% generic / 10% brand for primary-care prescribers, per CMS Office of the Actuary 2024 estimates. Higher brand share is common in specialty prescribing where generic equivalents are not available.
Medicare Part D Prescribing Data
CMS Medicare Part D prescriber-level data for calendar year 2023.
Prescribing Breakdown
- 30-Day Fills
- 1,263
- Total Day Supply
- 33,871
- Brand vs Generic
- 60% brand / 40% generic
- Brand Drug Cost
- $641K
- Antibiotic Claims
- 32
Patient Demographics
- Average Patient Age
- 74.9 years
- Avg HCC Risk Score
- 1.60
- Gender Split
- 54% female / 46% male
- Age Distribution
- <65: 12, 65-74: 96, 75-84: 73, 85+: 31
Top Prescribed Drugs (Medicare Part D)
Top drugs by claim count for calendar year 2023. Based on Medicare Part D data only.
What HETAL PATEL, M.D. prescribes most
Top Medicare Part D drugs by claim count, 2023
- Trelegy Ellipta
Trelegy Ellipta
195 claims
- Albuterol Sulfate …
Albuterol Sulfate Hfa
181 claims
- Prednisone
Prednisone
121 claims
- Breo Ellipta
Breo Ellipta
90 claims
- Fluticasone Propio… 48
Fluticasone Propionate
48 claims
- Anoro Ellipta 42
Anoro Ellipta
42 claims
- Symbicort 29
Symbicort
29 claims
- Famotidine 27
Famotidine
27 claims
| Drug | Claims |
|---|---|
| Trelegy Ellipta Fluticasone/Umeclidin/Vilanter | 195 |
| Albuterol Sulfate Hfa Albuterol Sulfate | 181 |
| Prednisone | 121 |
| Breo Ellipta Fluticasone/Vilanterol | 90 |
| Fluticasone Propionate | 48 |
| Anoro Ellipta Umeclidinium Brm/Vilanterol Tr | 42 |
| Symbicort Budesonide/Formoterol Fumarate | 29 |
| Famotidine | 27 |
| Omeprazole | 21 |
| Stiolto Respimat Tiotropium Br/Olodaterol Hcl | 16 |
* Counts below 11 are suppressed by CMS for patient privacy. Generic names shown where available from CMS Part D data.
Pulmonary Disease Physician Overview
How HETAL PATEL, M.D. fits within the Pulmonary Disease Physician landscape nationally.
HETAL PATEL, M.D.'s 964 claims are below the specialty average of 1,457.
Nearby Pulmonary Disease Physician Providers in New Jersey
Other clinicians with the same primary specialty enrolled in New Jersey, drawn from the same CMS NPPES roster as PATEL.
Compare Pulmonary Disease Physician nationally: see state-by-state distribution →
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Frequently Asked Questions
What is HETAL PATEL, M.D.'s specialty? ▼
How much does HETAL PATEL, M.D. prescribe under Medicare Part D? ▼
What is HETAL PATEL, M.D.'s Medicare quality score? ▼
Where is HETAL PATEL, M.D. located? ▼
What is HETAL PATEL, M.D.'s NPI number? ▼
Does HETAL PATEL, M.D. prescribe more brand-name or generic drugs? ▼
How many Pulmonary Disease Physician providers are there in the US? ▼
What drugs does HETAL PATEL, M.D. prescribe most often? ▼
Does HETAL PATEL, M.D. accept Medicare? ▼
How can I verify HETAL PATEL, M.D.'s credentials? ▼
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