Physician

Sanjay Kavathia, M.D.

According to 2025 Medicare claims, Sanjay Kavathia, M.D. (NPI: 1124078142) practices internal medicine in the Allentown-Bethlehem-Easton, PA-NJ market, with the plurality of this provider's patient population coming from Warren, NJ. This provider's primary affiliated billing organization is PRIMED MEDICAL CARE PC (NPI: 1972619807; TIN: 201995859) and primary practice location at 07840-1779. Kavathia is affiliated with the Optimus Healthcare Partners, LLC (ACO ID: A1059), participating under the MSSP model.

Kavathia's data goes back to 2015 and runs through 2024. For example, in 2024, this provider had 439 traditional Medicare patients, billed 5,501 HCPCS/CPT codes, and received $456,008 in Medicare payments. The top billing code was G0439 (Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit). Part D data shows 16,092 prescription claims across 624 beneficiaries totaling $1,341,832 in drug costs, led by Eliquis (Apixaban). DME data shows 262 claims. Open Payments data shows 64 records totaling $1,782. You can download detailed data with all billing codes (2015-2024). For more recent data, please contact us.

Over the past 10 years, this provider's Medicare Part B carrier billing has changed little. Concurrently, Part D prescription costs have risen steadily, from $905,891 to $1,341,832. In contrast, DME billing represents a smaller volume and moved up and down with repeated peaks and valleys, starting at $28,394 and ending at $37,653.

Part B Carrier Billing Trend

Medicare payment trend, with N of patients and claim lines in the table.

Year	Patients	Clm Lines	Payment
2015	629	7,067	$559,722
2016	637	6,609	$524,272
2017	577	6,055	$518,049
2018	590	7,681	$571,779
2019	531	6,616	$520,522
2020	521	8,412	$585,341
2021	484	6,698	$500,617
2022	490	7,255	$545,614
2023	486	6,505	$500,336
2024	439	5,501	$456,008

Part D Events Trend

Drug cost trend, with N of patients and prescription claims in the table.

Year	Patients	Claims	Drug Cost
2015	462	12,611	$905,891
2016	466	13,272	$940,319
2017	508	14,308	$940,897
2018	530	15,718	$1,157,615
2019	529	16,240	$1,279,101
2020	563	16,924	$1,205,067
2021	559	16,097	$1,209,775
2022	582	16,946	$1,405,289
2023	606	16,194	$1,420,871
2024	624	16,092	$1,341,832

DME Billing Trend

Medicare payment trend, with N of patients and DME claim records in the table.

Year	Patients	Claims	Payment
2015	188	682	$19,139
2016	190	873	$19,766
2017	105	515	$13,223
2018	75	514	$16,606
2019	74	363	$9,076
2020	63	387	$9,053
2021	48	392	$10,480
2022	19	341	$11,629
2023	18	257	$8,994
2024	13	262	$9,043

* / # = suppressed by CMS; 0 = reported zero; N/R = not reported or blank.

Top 5 Part B carrier billing codes in 2024

By total payments.

Code	Description	Patients	Clm Lines	Total Payment
G0439	Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	189	189	$142
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	240	771	$100
99497	Advance care planning, first 30 minutes	298	323	$70
99441	Telephone medical discussion with physician, 5-10 minutes	187	390	$39
36415	Insertion of needle into vein for collection of blood sample	192	297	$3

Top 5 Part D drugs in 2024

By total drug costs.

Drug	Generic	Claims	Total Day Supply	Total Drug Cost
Eliquis	Apixaban	322	9,479	$185,913
Mounjaro	Tirzepatide	83	2,634	$98,050
Xarelto	Rivaroxaban	132	4,238	$82,092
Farxiga	Dapagliflozin Propanediol	99	3,987	$74,761
Myrbetriq	Mirabegron	118	4,536	$68,217

Top 5 DME services in 2024

By Total Medicare Payment Amount.

HCPCS Code	HCPCS Description	Supplier Rental Indicator	Total Supplier Beneficiaries	Total Supplier Claims	Total Medicare Payment Amount
E1390	Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate	Y	N/R	56	$3,811
E1392	Portable oxygen concentrator, rental	Y	N/R	31	$1,351
A4414	Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each	N	N/R	12	$1,223
E0260	Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress	Y	N/R	18	$689
A5063	Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each	N	N/R	12	$676

Open Payments Summary in 2024

Category	Definition	Records	Total Reported Amount	Top Related Entity
General Payments	Reported payment or transfer-of-value amount.	64	$1,782	AstraZeneca Pharmaceuticals LP
Research Payments	Reported research-related payment or transfer-of-value amount.	0	$0	N/R
Ownership / Investment Interests	Reported value of ownership or investment interests.	0	$0	N/R

Explore More Providers

FAQ

What Medicare data is available for Sanjay Kavathia, M.D.?

Tedicare shows public-source Medicare data for Sanjay Kavathia, M.D. (NPI 1124078142), including provider identity, specialty, market context, Medicare Part B activity, Part D prescribing, DME records, Open Payments where available, billing organization details, and ACO affiliation signals where available. Profile data covers 2015-2024, with current attribution based on 2025 claims where available.

Does Sanjay Kavathia, M.D. have ACO affiliation data?

Sanjay Kavathia, M.D. is shown with ACO affiliation data for Optimus Healthcare Partners, LLC (MSSP, ACO ID A1059).

What billing organization is linked to Sanjay Kavathia, M.D.?

Sanjay Kavathia, M.D. is linked to PRIMED MEDICAL CARE PC (billing NPI 1972619807) in the available physician profile data.

Does Sanjay Kavathia, M.D. have Open Payments data?

Sanjay Kavathia, M.D. has 64 connected Open Payments records in the available 2024 summary data.

Can I download physician-level Medicare data from Tedicare?

Yes. Tedicare provides sample physician export data and paid custom physician data exports for research, planning, outreach, and market analysis. Exports can include physician profile fields, market and specialty context, billing organization details, ACO affiliation signals where available, and Medicare utilization data.