2026 NPPES data Sleep Medicine (Internal Medicine) Physician NPI 1295723575
Verify on CMS →

SANJAY PATEL

Sleep Medicine (Internal Medicine) Physician in PITTSBURGH, 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
170
Medicare Part D claims · 22 beneficiaries · Sleep Medicine (Internal Medicine) Physician avg: 1K
Generic prescribing
85%
generic claims · 15% brand-name · higher generic rates reduce patient out-of-pocket costs
MIPS score
77.5068/100
▼ 6 pts below national avg 83.1 · [object Object]
Industry payments
$32.4
1 payments · CMS Open Payments (Sunshine Act)

What the federal data shows

SANJAY PATEL reported a CMS MIPS final score of 77.5068/100 — below the 83.1 national average — and filed 170 Medicare Part D claims in 2023.

77.5068/100
MIPS score · -6 vs avg
170
Part D claims, 2023
85%
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.

SANJAY PATEL's MIPS score vs every scored U.S. clinician

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

78 24th percentile higher than 24% 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%). This entry sits in this band. 80–90: 129,887 scored providers (27%). Above this entry. 90–100: 189,403 scored providers (40%). Above this entry. 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)

SANJAY PATEL 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 SANJAY PATEL?

Below national average

NPI registry status

Active

Issued 10/11/2005

NPI 1295723575

Primary specialty

Sleep Medicine (Internal Medicine) Physician

Niche

857 US NPIs in this specialty

Medicare Part D claims

170 87% vs specialty avg

2023 prescription claims

Specialty avg: 1,310

MIPS final score

77.5068/100 5.593199999999996% pts

Above neutral band

vs 83.1 national avg

Specialty distribution in Pennsylvania

How Sleep Medicine (Internal Medicine) Physician compares to other specialties among Pennsylvania providers

Pennsylvania providers

Sleep Medicine (Internal Medicine) Physician share within Pennsylvania

1. Sleep Medicine (Internal Medicine) Physician42%2. Internal medicine21%3. Family medicine17%4. Surgical12%5. Pediatric8%
Sleep Medicine (Internal Medicine) Physician share within Pennsylvania

Medicare quality performance — MIPS

SANJAY PATEL's 2023 MIPS final score plotted against the Sleep Medicine (Internal Medicine) Physician national average

Below national average
MIPS Final Score
77.5068/100
vs 83.1 national avg · 2023 performance year

MIPS final score (Sleep Medicine (Internal Medicine) Physician) — 77.5068/100 vs national avg 83.1

0%100%National avg83%77.5%
MIPS final score (Sleep Medicine (Internal Medicine) Physician) — 77.5068/100 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).

SANJAY PATEL appears in the CMS NPPES registry as a Sleep Medicine (Internal Medicine) Physician provider at 3601 5TH AVE, PITTSBURGH, PA, 15213, with a listed phone of (412) 648-6161. NPI 1295723575 was issued on 10/11/2005. 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 170 prescription claims written by this provider, covering 22 Medicare beneficiaries and totaling roughly $135K in drug spend, split 15% brand-name and 85% generic by claim count, with an opioid prescribing rate of 10.6%. 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 77.5068/100 for the 2023 performance year (Quality 68.6144, Cost 56.4081), compared with the national average of 83.1.

Sleep Medicine (Internal Medicine) Physician is a narrow specialty nationwide, with 857 enrolled providers across 52 states and an average of 1,310 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

3601 5TH AVE
PITTSBURGH, PA 15213

Provider Details

NPI 1295723575
Specialty Sleep Medicine (Internal Medicine) Physician
Gender Male
NPI Issued 10/11/2005

CMS Quality Score (MIPS)

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

77.5068
Final Score
Avg: 83.1
68.6144
Quality
56.4081
Cost
100
Promoting Interoperability

Reporting: Group practice

Hospital and facility affiliations

Facilities where SANJAY PATEL 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.

UNIVERSITY OF PITTSBURGH PHYSICIANS
PITTSBURGH, 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 SANJAY PATEL. Source: openpaymentsdata.cms.gov.

Total received

$32

Largest payer

Avadel CNS Pharmaceuticals, LLC

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 SANJAY PATEL. To verify SANJAY PATEL'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.

Brand vs generic prescribing mix · Typical

SANJAY PATEL — brand share 15.0%
Specialty average (est.)

15% brand-name claims vs 85% generic, on 170 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.

170
Total Claims
$135K
Total Drug Cost
22
Medicare Beneficiaries

Prescribing Breakdown

30-Day Fills
198
Total Day Supply
5,862
Brand vs Generic
15% brand / 85% generic
Brand Drug Cost
$130K
Generic Drug Cost
$4K
Opioid Claims
18 (10.6% rate)

Patient Demographics

Average Patient Age
65.0 years
Avg HCC Risk Score
1.63

Top Prescribed Drugs (Medicare Part D)

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

What SANJAY PATEL 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
Venlafaxine Hcl Er
Venlafaxine Hcl
25
Trazodone Hcl
19
Modafinil
16
Clonazepam
15
Dextroamphetamine-Amphetamine
Dextroamphetamine/Amphetamine
13
Belsomra
Suvorexant
12
Zolpidem Tartrate
11

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

Sleep Medicine (Internal Medicine) Physician Overview

How SANJAY PATEL fits within the Sleep Medicine (Internal Medicine) Physician landscape nationally.

857
Sleep Medicine (Internal Medicine) Physician Providers in US
52
States with Sleep Medicine (Internal Medicine) Physician
1,310
Avg Claims per Provider

SANJAY PATEL's 170 claims are below the specialty average of 1,310.

Nearby Sleep Medicine (Internal Medicine) Physician Providers in Pennsylvania

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

Compare Sleep Medicine (Internal Medicine) Physician nationally: see state-by-state distribution →

Frequently Asked Questions

What is SANJAY PATEL's specialty?
SANJAY PATEL specializes in Sleep Medicine (Internal Medicine) Physician and practices in PITTSBURGH, Pennsylvania.
How much does SANJAY PATEL prescribe under Medicare Part D?
In 2023, SANJAY PATEL wrote 170 Medicare Part D claims totaling $135K in drug costs for 22 beneficiaries.
What is SANJAY PATEL's Medicare quality score?
SANJAY PATEL has a CMS MIPS Final Score of 77.5068/100 (Quality: 68.6144, Cost: 56.4081). The national average MIPS Final Score is 83.1. Source: CMS Merit-based Incentive Payment System (MIPS) 2023.
Where is SANJAY PATEL located?
SANJAY PATEL is located at 3601 5TH AVE, PITTSBURGH, PA, 15213. Phone: (412) 648-6161.
What is SANJAY PATEL's NPI number?
SANJAY PATEL's National Provider Identifier (NPI) is 1295723575, issued on 10/11/2005.
Does SANJAY PATEL prescribe more brand-name or generic drugs?
SANJAY PATEL's prescribing is 15% brand-name and 85% generic drugs by claim count, with $130K in brand drug costs.
Does SANJAY PATEL prescribe opioids?
Yes, SANJAY PATEL had 18 opioid claims in 2023 with an opioid prescribing rate of 10.6%.
How many Sleep Medicine (Internal Medicine) Physician providers are there in the US?
There are 857 Sleep Medicine (Internal Medicine) Physician providers across 52 states in the US. The average Sleep Medicine (Internal Medicine) Physician provider writes 1,310 Medicare Part D claims per year.
What drugs does SANJAY PATEL prescribe most often?
Based on 2023 Medicare Part D data, SANJAY PATEL's most frequently prescribed drugs include Venlafaxine Hcl Er, Trazodone Hcl, Modafinil. This reflects Medicare Part D prescriptions only and does not include commercial insurance or other payer types.
Does SANJAY PATEL accept Medicare?
SANJAY PATEL appears in CMS Medicare data with 170 Part D claims and 22 Medicare beneficiaries in 2023. Contact the provider's office directly to confirm current Medicare enrollment and accepted plans.
How can I verify SANJAY PATEL's credentials?
SANJAY PATEL's NPI is 1295723575. 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