PRAJEENA MAINALI D.O.
NPI 1053705160
Family Medicine in Fall River, MA

Active since March 26, 2015PECOS EnrolledAccepts Medicare Assignment
203 PLYMOUTH AVE STE 701, FALL RIVER, MA 02721(502) 235-5445(508) 235-5594 Get Directions Write a Review

NPPES record last updated: October 23, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Prajeena Mainali D.o. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRAJEENA MAINALI D.O. (NPI 1053705160) is an individual family medicine provider in Fall River, Massachusetts, licensed in Massachusetts (277316) and active in the NPI registry since March 2015. She is enrolled in Medicare PECOS, is affiliated with Saint Anne's Hospital, and is a graduate of Other (2015).

NPPES Registry Identity

NPI1053705160
Entity TypeIndividualFemale
Primary Taxonomy207Q00000X
Provider Legal NamePRAJEENA MAINALICredential: D.O.
Location Address203 PLYMOUTH AVE STE 701Fall River, MA 02721-4300
Mailing Address9 Turner CtRehoboth, MA 02769-2128 · (703) 795-6334
Fax(508) 235-5594
Sole ProprietorYes
Medical School CMSOtherGraduated 2015
Enumeration DateMarch 26, 2015
Last NPPES UpdateOctober 23, 2018
NPI 1053705160 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License Licensed in MA · 277316
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
203 PLYMOUTH AVE STE 701, Fall River, MA 02721

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Prajeena Mainali D.o. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7618259607
PECOS Enrollment IDI20181116001021
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 27

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month 99490
Chronic care management services involve a healthcare professional directing clinical staff in managing your chronic conditions. This includes the first 20 minutes per month of services like medication management, care coordination, and health monitoring to help improve your health and quality of life.
327 services90 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
263 services107 patients
Insertion of needle into vein for collection of blood sample 36415
This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
209 services96 patients
Hemoglobin a1c level 83036
Hemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.
126 services86 patients
Blood test, comprehensive group of blood chemicals 80053
A comprehensive group of blood chemicals test, also known as a comprehensive metabolic panel, is a blood test that measures your sugar level, electrolyte and fluid balance, kidney function, and liver function. This helps to check your body's overall health.
124 services88 patients
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count 85025
A Complete Blood Cell Count is a common test that measures various components of the blood, including red cells (carry oxygen), white cells (fight infection), and platelets (help blood clot). An automated test ensures accuracy. The differential count provides detailed information about white cell types.
115 services87 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Saint Anne's Hospital

Acute Care Hospitals · Fall River, MA
3/5 CMS rating
OwnershipProprietary
CMS Certification Number220020
Location795 Middle StreetFall River, MA 02721 · Bristol County
Emergency services

Southcoast Hospitals Group

Acute Care Hospitals · Fall River, MA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220074
Location363 Highland AvenueFall River, MA 02720 · Bristol County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 02721 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$90.70 typical visit price
range $58.86 – $177.36
Typical copayment $22.67 (range $14.71 – $44.34)
Most-billed visit code 99203
Established Patient
$103.48 typical visit price
range $19.11 – $144.84
Typical copayment $25.87 (range $4.77 – $36.21)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 5

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
8 suppliers31 claims53 services$6.69 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
5 suppliers15 claims20 services$1.11 avg. paid by Medicare
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
DME-Oxygen and Supplies · category DC002N
2 suppliers16 claims19 services$68.43 avg. paid by Medicare
Standard wheelchair K0001
DME-Wheelchairs · category DD000N
1 supplier12 claims12 services$14.07 avg. paid by Medicare
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
3 suppliers13 claims13 services$185.66 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner
203 PLYMOUTH AVE STE 701
FALL RIVER, MA 02721
Internal Medicine
203 PLYMOUTH AVE STE 701
FALL RIVER, MA 02721
Family Medicine
203 PLYMOUTH AVE STE 701
FALL RIVER, MA 02721
Internal Medicine
203 PLYMOUTH AVE STE 701
FALL RIVER, MA 02721
Nurse Practitioner (Primary Care)
203 PLYMOUTH AVE STE 701
FALL RIVER, MA 02721
Nurse Practitioner
203 PLYMOUTH AVE STE 701
FALL RIVER, MA 02721
Nurse Practitioner (Family)
203 PLYMOUTH AVE STE 701
FALL RIVER, MA 02721
Family Medicine
203 PLYMOUTH AVE STE 701
FALL RIVER, MA 02721

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Prajeena Mainali's NPI number?

The NPI number for Prajeena Mainali is 1053705160. It was assigned to this individual provider in the NPPES registry on March 26, 2015.

Where is Prajeena Mainali located?

Prajeena Mainali practices at 203 Plymouth Ave Ste 701, Fall River, MA 02721. The listed phone number is (502) 235-5445.

What is Prajeena Mainali's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Prajeena Mainali enrolled in Medicare?

Yes. Prajeena Mainali is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Prajeena Mainali accept?

Health plans from Anthem Blue Cross and Blue Shield list Prajeena Mainali as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Prajeena Mainali affiliated with any hospitals?

According to CMS data, Prajeena Mainali is affiliated with Saint Anne's Hospital and Southcoast Hospitals Group.

When was this NPI record last updated?

The NPPES record for Prajeena Mainali was last updated on October 23, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.