PRASAD PILLAI MD
NPI 1023174380
Internal Medicine - Hematology & Oncology in Antioch, CA

Quality Rating: 94.34 out of 100 score

NPI Status: Active since December 29, 2006

Contact Information

4721 DALLAS RANCH RD
ANTIOCH, CA
ZIP 94531
Phone: (925) 778-0679
Fax: (925) 778-3567

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Table of Contents

NPI Profile Information
Primary Taxonomy
Medicare Participation & PECOS Status
Areas of Expertise
Physician Visit Costs
Overall Quality Performance
Quality Reporting
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Male
Years of Experience 28
Internal Medicine
Hematology & Oncology
Accepts Medicare Approved Payment
PECOS Enrolled
Medicare Quality Reporting

About PRASAD PILLAI

This page provides the complete NPI Profile along with additional information for Prasad Pillai, an internist established in Antioch, California with a medical specialization in Internal Medicine, focusing in hematology & oncology and more than 28 years of experience. The healthcare provider is registered in the NPI registry with number 1023174380 assigned on December 2006. The practitioner's primary taxonomy code is 207RH0003X with license number A116899 (CA). The provider is registered as an individual and his NPI record was last updated 10 years ago.

NPI: 1023174380
Provider Name: PRASAD PILLAI MD
Gender: Male
Entity Type: Individual
Location Address: 4721 DALLAS RANCH RD ANTIOCH, CA 94531
Location Phone: (925) 778-0679
Location Fax: (925) 778-3567
Mailing Address: 2345 COUNTRY HILLS DRIVE ANTIOCH, CA 94509
Mailing Phone: (925) 418-0278
Medical School Name: OTHER
Graduation Year: 1998
Is Sole Proprietor?: No
Enumeration Date: 12-29-2006
Last Update Date: 07-08-2015
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An internist like Prasad Pillai is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Internal Medicine Hematology & Oncology
Taxonomy Code: 207RH0003X
Type: Allopathic & Osteopathic Physicians
License No.: A116899
License State: CA
Taxonomy Description: An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

Medicare Participation & PECOS Enrollment Status

Prasad Pillai is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Prasad Pillai is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

Is the provider registered in PECOS? Yes
PECOS PAC ID: 2163691429
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.
PECOS Enrollment ID: I20110803000593
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.
Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Administration of chemotherapy into vein, 1 hour or less
Administration of chemotherapy into vein, each additional hour
Blood test, comprehensive group of blood chemicals
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count
Ct scan of abdomen and pelvis with contrast
Ct scan of chest with contrast
Cyanocobalamin (vitamin b-12) level
Established patient office or other outpatient visit, 20-29 minutes
Established patient office or other outpatient visit, 30-39 minutes
Established patient office or other outpatient visit, 40-54 minutes
Ferritin (blood protein) level
Flow cytometry technique for dna or cell analysis, each additional marker
Flow cytometry technique for dna or cell analysis, first marker
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries
Folic acid level, serum
Follow-up hospital inpatient care per day, typically 25 minutes
Follow-up hospital inpatient care per day, typically 35 minutes
Infusion into a vein for therapy, prevention, or diagnosis concurrent with another infusion
Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less
Infusion into a vein for therapy, prevention, or diagnosis, additional sequential infusion, 1 hour or less
Initial hospital inpatient care per day, typically 50 minutes
Initial hospital inpatient care per day, typically 70 minutes
Injection of additional new drug or substance into vein
Injection of drug or substance under skin or into muscle
Injection, denosumab, 1 mg
Injection, dexamethasone sodium phosphate, 1 mg
Injection, diphenhydramine hcl, up to 50 mg
Injection, epoetin alfa, (for non-esrd use), 1000 units
Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units
Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use)
Injection, fosaprepitant, 1 mg
Injection, palonosetron hcl, 25 mcg
Insertion of needle into vein for collection of blood sample
Iron level
Lactate dehydrogenase (enzyme) level
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml
New patient office or other outpatient visit, 45-59 minutes
New patient office or other outpatient visit, 60-74 minutes
Nuclear medicine study from skull base to mid-thigh with ct scan
Oncology care model (ocm) monthly enhanced oncology services (meos) payment for ocm enhanced services. g9678 payments may only be made to ocm practitioners for ocm beneficiaries for the furnishment of enhanced services as defined in the ocm participation a
Psa (prostate specific antigen) measurement, total
Telephone medical discussion with physician, 11-20 minutes
Telephone medical discussion with physician, 21-30 minutes

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $50.58 for a new patient copayment and $29.87 for an established patient copayment.

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 94531 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99205

Average New Patient Price $202.35
Minimum New Patient Price $69
Maximum New Patient Price $202.35

Average New Patient Copayment $50.58
Minimum New Patient Copayment $17.25
Maximum New Patient Copayment $50.58

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

Average Established Patient Price $119.48
Minimum Established Patient Price $23.44
Maximum Established Patient Price $166.46

Average Established Patient Copayment $29.87
Minimum Established Patient Copayment $5.86
Maximum Established Patient Copayment $41.61

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Overall MIPS Quality Performance

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 94.34, based on four performance areas: quality, improvement activities, promoting interoperability, and cost. The purpose of this information is to help people with Medicare make informed decisions and incentivize doctors and clinicians to maximize performance.

The Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS Quality Payment Program (QPP). The MIPS program affects clinician reimbursement for Part B covered professional services and also rewards them for improving the quality of patient care and outcomes.

Final Score: 94.34 out of 100

The MIPS program evaluates providers across multiple categories with a specific weight for each category resulting a in a MIPS final score that ranges from 0 to 100 points. The MIPS Final Score determines whether providers receive a negative, neutral or positive MIPS payment adjustment.
Quality Score: 84.62

The Quality category assesses providers performance on clinical practices and patient outcomes under the traditional MIPS program. The quality measures help identify the quality of healthcare processes, outcomes, and patient experiences. The Quality measure category compromises 40% providers final MPIS scores.

There are six collection types for MIPS quality measures: Electronic Clinical Quality Measures (eCQMs), MIPS Clinical Quality Measures (CQMs), Qualified Clinical Data Registry (QCDR) Measures, Medicare Part B claims measures, CMS Web Interface measures and The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey.
Promoting Interoperability Score: 100

The Interoperability category measures the providers ability to use technology to exchange and make use of healthcare information in a way that is less burdensome and improves outcomes. The Interoperability measure category compromises 25% providers final MPIS scores.

The MIPS Interoperability measure focuses on the use of certified electronic health record technology (CEHRT) to improve patient access health information, the exchange of information between clinicians and pharmacies and the systematic collection, analysis, and interpretation of healthcare data.
Improvement Activities Score: 40

The Improvement Activities performance category evaluates the providers participation in clinical activities that support the improvement of clinical practice, care delivery, and outcomes. Providers have the option to choose 2 to 4 activities from an inventory of over 100 improvement activities. Providers typically choose the activities that best fit their needs. The improvement activities measure category compromises 15% providers final MPIS scores.

The Improvement measures aim to better patient engagement, patient safety and other areas of patient care. The Improvement Activities category compromises 15% of providers final MPIS scores.
Cost Score: 71.22

The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.

Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.
Cost Score: 71.22

The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.

Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.

Quality Reporting

The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

Quality Measure	Performance	Number of Patients
Breast Cancer Screening	26%	133
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
Closing the Referral Loop: Receipt of Specialist Report	3%	277
Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred
Colorectal Cancer Screening	22%	259
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
Diabetes: Medical Attention for Nephropathy	85%	68
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
Documentation of Current Medications in the Medical Record	91%	1556
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration
Engagement of patients through implementation of improvements in patient portal	Yes	N/A
Access to an enhanced patient portal that provides up to date information related to relevant chronic disease health or blood pressure control, and includes interactive features allowing patients to enter health information and/or enables bidirectional communication about medication changes and adherence.
e-Prescribing	96%	786
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Falls: Screening for Future Fall Risk	17%	247
Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period
Health Information Exchange	36%	94
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for at least one transition of care or referral.
Immunization Registry Reporting	Yes	N/A
The MIPS eligible clinician is in active engagement with a public health agency to submit immunization data.
Medication Reconciliation	92%	1469
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
Patient-Specific Education	78%	521
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
Pneumococcal Vaccination Status for Older Adults	27%	249
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine
Practice Improvements for Bilateral Exchange of Patient Information	Yes	N/A
Ensure that there is bilateral exchange of necessary patient information to guide patient care, such as Open Notes, that could include one or more of the following: • Participate in a Health Information Exchange if available; and/or • Use structured referral notes.
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan	53%	505
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2
Preventive Care and Screening: Influenza Immunization	22%	318
Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization
Preventive Care and Screening: Screening for Depression and Follow-Up Plan	15%	444
Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	9%	33
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Provide Patient Access	80%	523
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information.
Secure Messaging	14%	523
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period.
Security Risk Analysis	Yes	N/A
Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.
Specialized Registry Reporting	Yes	N/A
The MIPS eligible clinician is in active engagement to submit data to specialized registry. To earn a 5 % bonus in the promoting interoperability performance category score for submitting to one or more public health or clinical data registries also attest to PI_TRANS_PHCDRR_3_MULTI.
Use evidence-based decision aids to support shared decision-making.	Yes	N/A
Use evidence-based decision aids to support shared decision-making.
Use of decision support and standardized treatment protocols	Yes	N/A
Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs.
Use of High-Risk Medications in the Elderly	8% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better.	249
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication. 2) Percentage of patients who were ordered at least two of the same high-risk medication

NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1	0	2	3	1	7	4	3	8	0
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	0	4	3	2	7	8	3	16
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 0 + 4 + 3 + 2 + 7 + 8 + 3 + 1 + 6 + 24 = 60
Step 3: because the number obtained in step 2 ends in zero, the check digit is zero.
									0

The NPI number 1023174380 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location

The following 16 providers are registered at the same or nearby location.

EAST BAY MEDICAL ONCOLOGY-HEMATOLOGY ASSOCIATES, INC.

Internal Medicine

(Hematology & Oncology)

4721 DALLAS RANCH RD
ANTIOCH, CA
ZIP 94531

About PRASAD PILLAI

Location Map

Specialty - Primary Taxonomy

Internal Medicine Hematology & Oncology

Medicare Participation & PECOS Enrollment Status

Is the provider registered in PECOS? Yes

PECOS PAC ID: 2163691429

PECOS Enrollment ID: I20110803000593

Accepts Medicare Assignment? Yes

Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

Eligible to Order or Refer a Home Health Agency (HHA): Yes

Eligible to Order or Refer Power Mobility Devices: Yes

Areas of Expertise

Administration of chemotherapy into vein, 1 hour or less

Administration of chemotherapy into vein, each additional hour

Blood test, comprehensive group of blood chemicals

Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count

Ct scan of abdomen and pelvis with contrast

Ct scan of chest with contrast

Cyanocobalamin (vitamin b-12) level

Established patient office or other outpatient visit, 20-29 minutes

Established patient office or other outpatient visit, 30-39 minutes

Established patient office or other outpatient visit, 40-54 minutes

Ferritin (blood protein) level

Flow cytometry technique for dna or cell analysis, each additional marker

Flow cytometry technique for dna or cell analysis, first marker

Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries

Folic acid level, serum

Follow-up hospital inpatient care per day, typically 25 minutes

Follow-up hospital inpatient care per day, typically 35 minutes

Infusion into a vein for therapy, prevention, or diagnosis concurrent with another infusion

Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less

Infusion into a vein for therapy, prevention, or diagnosis, additional sequential infusion, 1 hour or less

Initial hospital inpatient care per day, typically 50 minutes

Initial hospital inpatient care per day, typically 70 minutes

Injection of additional new drug or substance into vein

Injection of drug or substance under skin or into muscle

Injection, denosumab, 1 mg

Injection, dexamethasone sodium phosphate, 1 mg

Injection, diphenhydramine hcl, up to 50 mg

Injection, epoetin alfa, (for non-esrd use), 1000 units

Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units

Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use)

Injection, fosaprepitant, 1 mg

Injection, palonosetron hcl, 25 mcg

Insertion of needle into vein for collection of blood sample

Iron level

Lactate dehydrogenase (enzyme) level

Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml

New patient office or other outpatient visit, 45-59 minutes

New patient office or other outpatient visit, 60-74 minutes

Nuclear medicine study from skull base to mid-thigh with ct scan

Oncology care model (ocm) monthly enhanced oncology services (meos) payment for ocm enhanced services. g9678 payments may only be made to ocm practitioners for ocm beneficiaries for the furnishment of enhanced services as defined in the ocm participation a

Psa (prostate specific antigen) measurement, total

Telephone medical discussion with physician, 11-20 minutes

Telephone medical discussion with physician, 21-30 minutes

Physician Visit Costs

New Patients Visit Costs *

Established Patients Visit Costs *

Overall MIPS Quality Performance

Final Score: 94.34 out of 100

Quality Score: 84.62

Promoting Interoperability Score: 100

Improvement Activities Score: 40

Cost Score: 71.22

Cost Score: 71.22

Quality Reporting

Reviews for PRASAD PILLAI MD

NPI Validation Check Digit Calculation

Other Providers at the Same Location

Frequently Asked Questions