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PRAKASH PAUDEL M.D.
NPI 1255731394
Internal Medicine in Marlborough, MA

Active since August 26, 2014PECOS EnrolledAccepts Medicare Assignment
157 UNION ST, MARLBOROUGH, MA 01752(508) 486-5678(508) 486-5677 Get Directions Write a Review

NPPES record last updated: October 29, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Oct 29, 2020, Jun 16, 2020 (2 updates tracked since 2020).

About Prakash Paudel M.d. NPPES

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

PRAKASH PAUDEL M.D. (NPI 1255731394) is an individual internal medicine provider in Marlborough, Massachusetts, licensed in Massachusetts (260595) and active in the NPI registry since August 2014. He is enrolled in Medicare PECOS, is affiliated with Umass Memorial Medical Center/university Campus, and maintains a secondary practice location in Worcester.

NPPES Registry Identity

NPI1255731394
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NamePRAKASH PAUDELCredential: M.D.
Location Address157 UNION STMarlborough, MA 01752-1228
Mailing AddressPo Box 415348Boston, MA 02241-5348 · (800) 225-8885 · Fax (508) 334-1977
Phone(508) 486-5678
Fax(508) 486-5677
Sole ProprietorYes
Medical School CMSOtherGraduated 2010
Enumeration DateAugust 26, 2014
Last NPPES UpdateOctober 29, 20202 updates tracked since enumeration
NPPES CertifiedOctober 29, 2020
✔ NPI 1255731394 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in MA · 260595
Definition
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.
157 UNION ST, Marlborough, MA 01752
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Secondary Practice Location 1

Location 1119 Belmont StWorcester, MA 01605-2903 · Phone (508) 334-8515 · Fax (508) 334-6490

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Taro Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Prakash Paudel M.d. 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 ID3678793429
PECOS Enrollment IDI20171227002409
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.

Medicare Billing Reassignments

4

Medicare enrollment records show Prakash Paudel reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Marlborough Hospitalist Group, PLLC
Same address
Hospitalist
157 UNION ST
Marlborough, MA 01752
  • Reassigned Medicare billing, Massachusetts enrollment
  • 88 clinicians in this Medicare group
NPI 1316639321 (508) 481-5000
Umass Memorial Medical Group Inc
12 mi
Internal Medicine
55 LAKE AVE N
Worcester, MA 01655
  • Reassigned Medicare billing, Massachusetts enrollment
  • 2,902 clinicians in this Medicare group
NPI 1760445373 (508) 334-1000
Sound Physicians Of Massachusetts, Inc
28 mi
Internal Medicine
150 YORK ST
Stoughton, MA 02072
  • Reassigned Medicare billing, Massachusetts enrollment
  • 337 clinicians in this Medicare group
NPI 1245784446 (781) 344-0600
Berkshire Medical Center, Inc
87 mi
General Acute Care Hospital
725 NORTH ST
Pittsfield, MA 01201
  • Reassigned Medicare billing, Massachusetts enrollment
  • 394 clinicians in this Medicare group
NPI 1295765261 (413) 447-2000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 4

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.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233
Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.
213 services89 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
132 services54 patients
Hospital discharge day management, more than 30 minutes 99239
Hospital discharge day management over 30 minutes involves a detailed process to ensure a smooth transition from hospital to home. It includes final examinations, discussion of your hospital stay, post-discharge instructions, and coordinating follow-up care.
46 services45 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
19 services19 patients

Hospital Affiliations CMS Care Compare

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

Umass Memorial Medical Center/University Campus

Acute Care Hospitals · Worcester, MA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220163
Location55 Lake Avenue NorthWorcester, MA 01655 · Worcester County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 01752 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
$144.11 typical visit price
range $63.72 – $189.86
Typical copayment $36.02 (range $15.93 – $47.46)
Most-billed visit code 99204
Established Patient
$111.18 typical visit price
range $21.07 – $155.29
Typical copayment $27.79 (range $5.26 – $38.82)
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

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

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
3 suppliers21 claims21 services$64.85 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 20

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

JUDY WANG
Family Medicine
157 UNION ST
MARLBOROUGH, MA 01752
Middlesex County (508) 486-5678
EVANDRO NUNES ANDRADE PMHNP
Nurse Practitioner (Psychiatric/Mental Health)
157 UNION ST
MARLBOROUGH, MA 01752
Middlesex County (508) 486-5400
SUSAN E DONOHUE M.D.
Internal Medicine (Hematology & Oncology)
157 UNION ST
MARLBOROUGH, MA 01752
Middlesex County (508) 486-6700
BRENDA FRAN MACK PT
Physical Therapist
157 UNION ST
MARLBOROUGH, MA 01752
Middlesex County (508) 486-5900
DR. FAN ZHU M.D.
Radiology (Radiation Oncology)
157 UNION ST
MARLBOROUGH, MA 01752
Middlesex County (508) 486-6780
MARC V. BISCEGLIA PA-C
Physician Assistant
157 UNION ST, DEPARTMENT OF EMERGENCY MEDICINE
MARLBOROUGH, MA 01752
Middlesex County (508) 421-1400
OLUWASEUN ADARAMOLA
Internal Medicine
157 UNION ST
MARLBOROUGH, MA 01752
Middlesex County (508) 486-5678
MARLBOROUGH HOSPITAL CORP
Dietitian, Registered
157 UNION ST
MARLBOROUGH, MA 01752
Middlesex County (508) 481-5000

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 Prakash Paudel's NPI number?

The NPI number for Prakash Paudel is 1255731394. It was assigned to this individual provider in the NPPES registry on August 26, 2014.

Where is Prakash Paudel located?

Prakash Paudel practices at 157 Union St, Marlborough, MA 01752. The listed phone number is (508) 486-5678.

What is Prakash Paudel's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Prakash Paudel enrolled in Medicare?

Yes. Prakash Paudel 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.

Which organizations bill Medicare for Prakash Paudel's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Prakash Paudel reassigns Medicare benefits to 4 organizations: Marlborough Hospitalist Group, PLLC (Marlborough, MA), Umass Memorial Medical Group Inc (Worcester, MA), Sound Physicians Of Massachusetts, Inc (Stoughton, MA) and Berkshire Medical Center, Inc (Pittsfield, MA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Prakash Paudel's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Prakash Paudel accept?

Health plans from Taro Health list Prakash Paudel 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 Prakash Paudel affiliated with any hospitals?

According to CMS data, Prakash Paudel is affiliated with Umass Memorial Medical Center/University Campus.

When was this NPI record last updated?

The NPPES record for Prakash Paudel was last updated on October 29, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.