Medicare Enrolled
Dr. Sanjay Upadhyay, M.D.
Family Medicine · Philadelphia, PA
Practice pattern: Clinical Cardiology
— Primarily office-based clinical cardiology
Low-engagement
Very High
DATA COVERAGE
Data in 4 of 4 federal sources
Measures public federal data availability — not provider quality
Informational, not a quality rating.
This page presents federal public records about Dr. Upadhyay from CMS (NPPES, Open Payments, Medicare Provider Utilization, PECOS). It is not medical advice, an endorsement, or a judgment of clinical quality. Always consult the provider directly and a licensed clinician for medical decisions. Read methodology →
Are you Dr. Upadhyay?
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What this data tells you about Dr. Upadhyay
Dr. Sanjay Upadhyay is a family medicine specialist in Philadelphia, PA, with 18 years of NPI registration. Based on federal Medicare data, Dr. Upadhyay performed 1,637 Medicare services across 1,393 unique beneficiaries.
Between the years covered by Open Payments, Dr. Upadhyay received a total of $670 from 13 pharmaceutical and/or device companies across 33 individual payments. These payments are legal, publicly disclosed under the federal Sunshine Act, and common in family medicine. Most payments are for meals and travel — low-value interactions common across virtually all practicing physicians. Patients may wish to discuss these relationships with their provider.
The Data Coverage level for Dr. Upadhyay is Very High — reflecting how much public federal data is available about this provider. Patients are encouraged to use this data as one of several factors when choosing a healthcare provider.
✓ 18 years in practice
▲ Top 12% volume in PA
$670 industry payments
Medicare Practice Summary
Medicare Utilization ↗1,637
Medicare services
Top 12% in PA for family medicine
1,393
Unique beneficiaries
$51
Avg. Medicare payment
Medicare patients only (65+ / disabled) · How to read this →
~91 Medicare services per year of practice
Top procedures by volume
Ranked by number of services performed for Medicare patients. Avg. submitted charge is what the provider billed; avg. Medicare payment is what CMS paid.
| Procedure | Volume | Avg. paid | Avg. submitted |
|---|---|---|---|
| Office visit, established patient (20-29 min) An office visit for an existing patient lasting between 20 and 29 minutes. The visit involves medical evaluation and management of the patient's condition. |
232 | $75 | $227 |
| Office visit, established patient (30-39 min) A follow-up office visit for an existing patient lasting between 30 and 39 minutes. The visit involves medical evaluation and management of the patient's condition. |
213 | $109 | $332 |
| Blood draw (venipuncture) Insertion of a needle into a vein to collect a blood sample. |
177 | $8 | $9 |
| Complete blood count (CBC) with differential An automated laboratory test that measures the levels of red blood cells, white blood cells, and platelets in the blood, including a breakdown of the different types of white blood cells. |
122 | $7 | $29 |
| Comprehensive metabolic blood panel A blood test that measures a group of chemicals, including glucose, electrolytes, and kidney and liver function markers. |
112 | $10 | $58 |
| Annual wellness visit, follow-up A follow-up annual wellness visit that includes a personalized prevention plan of service. |
67 | $150 | $359 |
| Lipid panel (cholesterol and triglycerides) A blood test that measures cholesterol and triglyceride levels. |
62 | $13 | $82 |
| Remote patient monitoring management, 20 min/month Management based on results from remote vital sign monitoring for the first 20 minutes per calendar month. |
60 | $46 | $180 |
| Assessment of emotional or behavioral problems An evaluation to identify and understand emotional or behavioral issues. This process involves reviewing symptoms and behaviors to determine the nature of the concerns. |
57 | $4 | $31 |
| Electrocardiogram (EKG), 12-lead A standard heart rhythm test using at least 12 leads to record electrical activity. A healthcare provider interprets the results and provides a written report. |
55 | $12 | $110 |
| Flu vaccine, high-dose High-dose seasonal influenza vaccine for adults aged 65 and older. Contains four times the antigen of standard-dose flu vaccines (60 mcg per strain), split-virus formulation, preservative-free, single-dose syringe. |
54 | $70 | $112 |
| Flu vaccine administration This procedure involves the administration of the influenza virus vaccine. It covers the process of delivering the vaccine to the patient. |
54 | $36 | $50 |
| Thyroid stimulating hormone (TSH) test A blood test that measures the level of thyroid stimulating hormone to evaluate thyroid function. |
45 | $16 | $75 |
| Remote patient monitoring device, 30 days Initial setup of devices for remote monitoring of body functions with daily data transmission or alerts. This service covers the first 30 days of the monitoring period. |
44 | $49 | $225 |
| Hemoglobin A1c test (diabetes monitoring) A blood test that measures your average blood sugar levels over the past two to three months. |
37 | $9 | $58 |
| Prothrombin time test (blood clotting) A laboratory test that measures how long it takes for blood to clot. This procedure evaluates the body's coagulation process. |
30 | $4 | $20 |
| Transitional care management services, moderate complexity Services provided to coordinate care during the transition from an inpatient or other facility setting back to the community. This includes follow-up and management of a health problem of at least moderate complexity. |
29 | $193 | $793 |
| Pneumonia vaccine administration This procedure involves the injection of a vaccine to protect against pneumococcal disease. It is administered by a healthcare provider. |
25 | $36 | $52 |
| Basic metabolic blood panel A blood test that measures a group of basic chemicals, including total calcium levels. |
23 | $8 | $40 |
| Coagulation assessment blood test A blood test that measures how long it takes for blood to clot. The sample can be plasma or whole blood. |
22 | $6 | $39 |
| Pneumococcal conjugate vaccine (PCV15) An intramuscular injection of the 15-valent pneumococcal conjugate vaccine. This vaccine protects against 15 types of pneumococcal bacteria. |
20 | $241 | $615 |
| Urinalysis with microscopic exam A urine test performed manually that includes examining the sample under a microscope to check for abnormalities. |
19 | $3 | $15 |
| New patient office visit (45-59 min) An initial office visit for a new patient lasting between 45 and 59 minutes. This code covers the total time spent by the physician or qualified healthcare professional on the date of the encounter. |
19 | $127 | $510 |
| Urine microalbumin test (kidney screening) A laboratory test that measures the amount of microalbumin, a small protein, in a urine sample. This test is used to detect early signs of kidney damage. |
16 | $5 | $49 |
| Creatinine test (kidney function) A blood test that measures the amount of creatinine to assess kidney function or detect muscle injury. |
16 | $5 | $25 |
| PSA test (prostate cancer screening) A blood test that measures the level of prostate-specific antigen to screen for prostate cancer. |
14 | $18 | $78 |
| Respiratory virus test for SARS-CoV-2, influenza A/B, and RSV A laboratory test that detects the presence of SARS-CoV-2 (COVID-19), influenza A, influenza B, and respiratory syncytial virus (RSV) in an upper respiratory specimen. |
13 | $140 | $356 |
How to read this data: This reflects Medicare patients only (typically 65+). Payment amounts are what Medicare paid the provider, not your out-of-pocket cost. A higher procedure volume generally indicates more experience with that procedure.
Industry Payment Transparency
Open Payments through 2022 ↗$670
Total received (2018-2022)
Avg $134/year across 5 years
Top 37% in PA for family medicine
A higher payment rank reflects disclosed industry relationships (consulting, research, speaking) common among subspecialists — not wrongdoing.
13
Companies
33
Individual payments
All payments are legal and publicly reported · Not evidence of wrongdoing · How to interpret →
Payment profile
Industry payments classified by relationship type. Not all payments are equal — research and consulting reflect different relationships than speaking programs or meals.
Meals & Travel
Food, beverages, travel, and lodging — typically low-value
$670 (100.0%)
Payment trend by year
Annual totals from pharmaceutical and medical device companies.
2022
$90
2021
$15
2020
$66
2019
$126
2018
$372
Payments by company (2022)
Consulting
Speaking
Meals & Travel
Research
ViiV Healthcare Company
$44
Novo Nordisk Inc
$25
Merck Sharp & Dohme LLC
$21
Top 3 companies account for 100.0% of 2022 payments
All-time payments by company (2018-2022) ›
SANOFI-AVENTIS U.S. LLC
$179
Astellas Pharma US Inc
$125
GlaxoSmithKline, LLC.
$89
PFIZER INC.
$73
ViiV Healthcare Company
$44
Janssen Pharmaceuticals, Inc
$31
Novo Nordisk Inc
$25
Novartis Pharmaceuticals Corporation
$23
Merck Sharp & Dohme LLC
$21
Sunovion Pharmaceuticals Inc.
$16
Theratechnologies Inc.
$15
Gilead Sciences, Inc.
$14
Phadia US Inc.
$13
Top 3 companies account for 58.8% of all-time payments
Associated products mentioned in payments ›
ANORO · ANORO ELLIPTA · APRETUDE · CHANTIX · DOVATO · ENTRESTO · ISENTRESS · ImmunoCAP · LANTUS · LATUDA · Ozempic · TOUJEO · TRELEGY ELLIPTA · TROGARZO · XARELTO
Should you be concerned? Payments from pharmaceutical and device companies are legal and common — 57% of U.S. physicians receive at least one. They often reflect legitimate consulting, research, or education. What matters is whether a recommended drug or device appears in your doctor's payment records. If so, consider asking your doctor about it. How to interpret this data →
Most payments (100%) are for meals and travel — low-value interactions that are common across virtually all practicing physicians.
Geographic Context
Family medicine physicians within 10 mi
2,409
Per 100K population
152.2
County median income
$60,698
Nearest hospital
KENSINGTON HOSPITAL
1.1 mi
1.1 mi
Data Sources
| Provider Registry | ✓ NPPES | Weekly updates |
| Medicare Enrollment | ✓ PECOS | Monthly updates |
| Practice Data | ✓ Medicare Util. | Annual (CY lag) |
| Industry Payments | ✓ Open Payments | CY 2022 |
| Disciplinary History | — Not public | N/A |
This provider has data in 4 of 4 available federal datasets, with a Data Coverage level of Very High. This reflects how much public data is available about a provider. How we calculate this →
Summary
Dr. Upadhyay is a clinical cardiology specialist, with above-average Medicare volume (top 12% in PA), with low-engagement industry engagement, with 18 years of NPI registration.
This summary is auto-generated from federal data, describing data availability and patterns. Read our methodology →
Frequently Asked Questions
Is Dr. Upadhyay experienced with office visit, established patient (20-29 min)?
Based on Medicare claims data, Dr. Upadhyay performed 232 office visit, established patient (20-29 min) services. Research suggests that higher procedure volume is often associated with better outcomes, particularly for complex procedures. Note that Medicare data only captures patients aged 65 and older, so the total practice volume across all patients is likely higher.
Does Dr. Upadhyay receive payments from pharmaceutical companies?
Yes. Dr. Upadhyay received a total of $670 from 13 companies across 33 individual payments. These payments are legal, publicly disclosed under the federal Sunshine Act, and common among physicians — 57% of all U.S. physicians receive at least one industry payment. Patients may wish to ask their doctor about these relationships, especially if a recommended drug or device appears in the payment records.
How do Dr. Upadhyay's costs compare to other family medicine physicians in Philadelphia?
Dr. Upadhyay's average Medicare payment per service is $51. Note that these figures represent what Medicare pays, not your out-of-pocket cost, which depends on your specific insurance plan and deductible. Procedure-level data above shows both what was submitted and what Medicare paid for each service type.
What does Data Coverage mean?
Data Coverage (currently Very High for Dr. Upadhyay) measures how much public federal data is available about a provider. It is not a quality rating. A "Very High" or "High" level means the provider has data across multiple federal sources (NPPES, PECOS, Medicare Utilization, Open Payments), indicating a long track record of practice, Medicare participation, and industry disclosure. A "Low" or "Moderate" level may simply mean the provider is newer, does not see Medicare patients, or has not received any industry payments — none of which are inherently negative. Read our full methodology →
Is this data up to date?
Each data source has its own update cycle. Provider registry data (NPPES) is updated weekly. Medicare enrollment (PECOS) is updated monthly. Medicare practice data has a ~2 year lag — the most recent available is typically 2 years prior. Industry payment data (Open Payments) is published annually, usually in June, covering the prior calendar year. We display the data date prominently on each section so you always know how current it is. See our data freshness policy →
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About this page
All data on this page is sourced verbatim from public federal records published by the U.S. Centers for Medicare & Medicaid Services (CMS): NPPES ↗, Open Payments ↗, Medicare Provider Utilization ↗, and PECOS. Publication is mandated by the Physician Payments Sunshine Act (§6002 ACA, 42 U.S.C. §1320a-7h) and the Freedom of Information Act.
This page is not medical advice, an endorsement, a recommendation, or a quality rating. Data Coverage reflects data completeness — how much federal information exists for this provider — not clinical performance, patient outcomes, or quality of care. Always verify information directly with the provider and consult a licensed clinician before making medical decisions.
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