Active NPI 1215223722 Individual Practitioner Male Practitioner

Dr. Niraj Niraula , MD

Internal Medicine - Pulmonary Disease • Youngstown, OH

✓ Accepts Medicare Assignment Telehealth Available

Professional Overview & Biography Verified Profile Summary

Dr. Niraj Niraula, MD is a certified Internal Medicine - Pulmonary Disease practicing in Youngstown, OH. With approximately 22 years of clinical experience since completing medical education in 2004, Dr. Niraula delivers high-quality medical care to the local community at 4694 BELMONT AVE.

Dr. Niraula is affiliated with Mercy Health Physicians Youngstown Specialty Care Llc and accepts Medicare assignment . Telehealth and virtual consultation options are available for eligible patients.

Frequently performed procedures and clinical services include critical care, first, subsequent hospital care with moderate levelof medical decision making, if using time, at least, established patient outpatient office visit. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

4694 Belmont Ave

Youngstown, OH 445051012

Telephone 3304804080

Fax 3304804078

Medicare Profile & Education

Medical School

Other

Graduation Year

2004

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

Telehealth Services Available

Specialty Benchmarks & Practice Insights

Comparative analytics for Internal Medicine - Pulmonary Disease in Youngstown, OH

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

22 Yrs +0.1 yrs vs City Avg

City Avg: 21.9 Yrs

State Avg: 27.8 Yrs

Regional Practice Density

13 Specialists

Practicing in Youngstown, OH (672 Statewide)

Telehealth Adoption Rate

23.1% Regional Adoption

✓ Offers Virtual Consultations

Medicare Pricing Discount

44.0% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Niraula (22 Years) 22 Yrs

Youngstown Specialty Average (21.9 Years) 21.9 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99291 Critical care, first 30-74 minutes	256	86	$320.00	$202.46
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	159	74	$149.00	$111.31
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	61	39	$215.77	$134.64
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	45	26	$104.00	$74.61
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	38	38	$198.00	$124.12
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	18	18	$271.83	$172.45
31624 Irrigation and suction of lung airways to obtain cells using an endoscope	16	16	$241.00	$20.05

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99291 Critical care, first 30-74 minutes	286	95	$347.22	$204.72
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	123	51	$151.20	$115.00
99292 Critical care, each additional 30 minutes	28	24	$161.00	$97.74
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	23	14	$144.00	$94.04
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	20	20	$198.00	$125.96
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	17	15	$214.00	$137.99
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	16	16	$269.00	$174.76
31624 Irrigation and suction of lung airways to obtain cells using an endoscope	15	15	$241.00	$43.52
94060 Test to measure expiratory airflow and volume changes before and after medication administration	15	13	$21.00	$9.82
94010 Test to measure expiratory airflow and volume	11	11	$24.00	$7.86

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99291 Critical care, first 30-74 minutes	127	58	$507.53	$214.72
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	76	41	$200.16	$99.83
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	23	22	$252.00	$131.80
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	22	16	$253.00	$124.66
94060 Test to measure expiratory airflow and volume changes before and after medication administration	19	19	$22.89	$10.12
94729 Test to examine how well the lungs exchange gases	19	19	$18.00	$8.78
94727 Determination of lung volumes using gas dilution or washout	17	17	$24.00	$11.80

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99291 Critical care, first 30-74 minutes	248	93	$544.02	$217.91
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	112	64	$202.81	$101.25
94729 Test to examine how well the lungs exchange gases	50	50	$18.00	$8.65
94060 Test to measure expiratory airflow and volume changes before and after medication administration	48	48	$23.00	$10.01
94727 Determination of lung volumes using gas dilution or washout	44	44	$24.00	$11.60
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	39	30	$251.28	$126.50
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	25	25	$265.96	$133.49
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	11	11	$329.00	$164.49

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99291 Critical care, first 30-74 minutes	214	82	$483.13	$225.16
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	138	81	$181.84	$104.71
99442 Telephone medical discussion with physician, 11-20 minutes	22	21	$124.23	$72.63
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	21	21	$185.67	$105.27
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	17	17	$488.00	$203.75
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	16	13	$172.00	$72.39
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	12	12	$241.00	$138.63

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99291 Critical care, first 30-74 minutes	166	79	$476.51	$219.54
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	140	96	$180.17	$100.73
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	60	49	$184.66	$105.21
99221 Initial hospital inpatient care per day, typically 30 minutes	44	44	$175.32	$98.30
94729 Test to examine how well the lungs exchange gases	39	39	$15.00	$9.12
94727 Determination of lung volumes using gas dilution or washout	38	38	$20.00	$12.29
94060 Test to measure expiratory airflow and volume changes before and after medication administration	36	36	$21.00	$12.98
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	31	30	$488.00	$193.03
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	26	18	$172.00	$71.70
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	24	24	$281.71	$159.84
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	11	11	$190.00	$104.72
31624 Irrigation and suction of lung airways to obtain cells using an endoscope	11	11	$531.00	$31.99

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	116	69	$173.00	$102.15
99291 Critical care, first 30-74 minutes	83	45	$459.00	$219.06
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	38	35	$178.00	$101.68
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	35	35	$275.00	$156.44
99221 Initial hospital inpatient care per day, typically 30 minutes	19	18	$171.00	$99.59
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	16	16	$190.00	$104.15
31624 Irrigation and suction of lung airways to obtain cells using an endoscope	14	14	$531.00	$71.27
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	13	13	$239.00	$140.53
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	11	11	$488.00	$198.82

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	105	66	$173.00	$101.15
99291 Critical care, first 30-74 minutes	98	44	$459.00	$219.03
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	29	29	$186.28	$100.52
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	27	27	$275.00	$145.14
94060 Test to measure expiratory airflow and volume changes before and after medication administration	12	12	$33.00	$12.80
94729 Test to examine how well the lungs exchange gases	12	12	$27.17	$9.00
94727 Determination of lung volumes using gas dilution or washout	12	12	$28.33	$12.13
99221 Initial hospital inpatient care per day, typically 30 minutes	11	11	$171.00	$99.15
31624 Irrigation and suction of lung airways to obtain cells using an endoscope	11	11	$531.00	$99.12

Medical Specialties & State Licenses

CMS Verified: 2022-10-12

Internal Medicine - Pulmonary Disease Primary Specialty

NUCC Taxonomy Code: 207RP1001X

State License OH 35.130116

An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.

Internal Medicine

NUCC Taxonomy Code: 207R00000X

State License TN 51496

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.

Internal Medicine - Pulmonary Disease

NUCC Taxonomy Code: 207RP1001X

State License TN 51496

Hospital & Practice Group Affiliations

Mercy Health Physicians Youngstown Specialty Care Llc

1001 Covington St, Youngstown, OH 445101617

Phone: 3304803195

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners

Dr. Kowriah Amirthalingam , MD

Internal Medicine - Pulmonary Disease

NPI 1699769968

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events

📍

Updated Practice Location October 12, 2022

Registered at 4694 BELMONT AVE, YOUNGSTOWN, OH 445051012 (Tel: 3304804080)

📍

Updated Business Mailing Address October 12, 2022

Registered at 4694 BELMONT AVE, YOUNGSTOWN, OH 445051012 (Tel: 3304804080)

✅

NPI Profile Active November 10, 2016

NPI status registered as active in NPPES database

📍

Updated Practice Location November 10, 2016

Registered at 979 E. THIRD STREET, SUITE #C-735, CHATTANOOGA, TN 374032141 (Tel: 4237789101)

📍

Updated Business Mailing Address November 10, 2016

Registered at 975 E 3RD ST, ATTN: PROVIDER ENROLLMENT, CHATTANOOGA, TN 374032147 (Tel: 4237789101)

👤

Provider Name / Credentials Updated November 10, 2016

Recorded as NIRAJ NIRAULA, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) November 10, 2016

Internal Medicine (License #51496 in TN)

🟢

Initial NPI Registration & Enumeration June 22, 2011

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1215223722

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: June 22, 2011

Last Update: October 12, 2022

Sole Proprietor: No

Update or Correct Profile

Mailing Address

4694 Belmont Ave

Youngstown, OH 445051012

Phone: 3304804080

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.