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PRATIBHA AVINASH KULKARNI M.D.
NPI 1306867478
Internal Medicine in Millburn, NJ

Active since July 22, 2006PECOS Enrolled
84.01/100
CMS Quality Rating
116 MILLBURN AVE, SUITE # 108, MILLBURN, NJ 07041(973) 564-5227 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Pratibha Avinash Kulkarni M.d. NPPES

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

PRATIBHA AVINASH KULKARNI M.D. (NPI 1306867478) is an individual internal medicine provider in Millburn, New Jersey, licensed in New Jersey (MA 41977) and active in the NPI registry since July 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1306867478
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NamePRATIBHA AVINASH KULKARNICredential: M.D.
Location Address116 MILLBURN AVE, SUITE # 108Millburn, NJ 07041-1943
Mailing Address297 Walnut StLivingston, NJ 07039-5009 · (973) 564-5227
Phone(973) 564-5227
Sole ProprietorYes
Enumeration DateJuly 22, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1306867478 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in NJ · MA 41977
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.
116 MILLBURN AVE, Millburn, NJ 07041
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Other Identifiers 3

Medicare UPINA64570NJ
Medicare ID-Type Unspecified454929NJ
Medicaid1883402NJ

Accepted Insurance

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

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Pratibha Avinash Kulkarni M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Reassignment

Medicare enrollment records show Pratibha Kulkarni reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Optum Medical Care Of New Jersey PC
32 mi
Pediatrics
1 DAKOTA DR
New Hyde Park, NY 11042
  • Reassigned Medicare billing, New Jersey enrollment
  • 417 clinicians in this Medicare group
NPI 1578665048 (516) 627-1811

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 07041 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
$144.86 typical visit price
range $63.84 – $190.92
Typical copayment $36.21 (range $15.96 – $47.73)
Most-billed visit code 99204
Established Patient
$111.57 typical visit price
range $20.97 – $155.92
Typical copayment $27.89 (range $5.24 – $38.98)
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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

84.01/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality68.67
Promoting Interoperability98
Improvement Activities40
Cost76.48

Reported Quality Measures

Breast Cancer Screening
66%129 patients3/55-star benchmark: 93%
Cervical Cancer Screening
50%217 patients3/55-star benchmark: 98%
Closing the Referral Loop: Receipt of Specialist Report
16%329 patients1/55-star benchmark: 87%
Controlling High Blood Pressure
58%203 patients3/55-star benchmark: 91%
Diabetes: Eye Exam
3%94 patients1/55-star benchmark: 100%
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
Lower rates are better for this measure.
24%94 patients4/55-star benchmark: 91%
Documentation of Current Medications in the Medical Record
99%1,054 patients4/55-star benchmark: 100%
Falls: Screening for Future Fall Risk
16%110 patients1/55-star benchmark: 100%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
41%452 patients2/55-star benchmark: 98%
Preventive Care and Screening: Screening for Depression and Follow-Up Plan
92%415 patients4/55-star benchmark: 97%
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
26%494 patients2/55-star benchmark: 61%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Patients screened: 7% · 416 patients
6%416 patients
Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
82%159 patients4/55-star benchmark: 91%
Use of High-Risk Medications in Older Adults
Lower rates are better for this measure.
Patients appropriateDiagnosis: 0% · 116 patients
Patients totalRate: 5% · 117 patients
5%117 patients4/55-star benchmark: 100%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Other Providers at the Same Location NPPES 16

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

DENTAL CHARM LLC
Clinic/Center (Dental)
116 MILLBURN AVE, SUITE 109
MILLBURN, NJ 07041
Essex County (973) 921-9097
RAJENDRA DESAI MD
Internal Medicine (Cardiovascular Disease)
116 MILLBURN AVE, SUITE 213
MILLBURN, NJ 07041
Essex County (973) 376-8454
DR. YATINDER BAINS M.D.
Internal Medicine (Gastroenterology)
116 MILLBURN AVE, SUITE # 214
MILLBURN, NJ 07041
Essex County (973) 376-2121
DR. GEORGE KIHICZAK M.D.
Dermatology (Procedural Dermatology)
116 MILLBURN AVE, SUITE 111
MILLBURN, NJ 07041
Essex County (973) 467-5499
MRS. QAISRA YASMIN SAEED MD
Internal Medicine (Cardiovascular Disease)
116 MILLBURN AVE, SUITE 214
MILLBURN, NJ 07041
Essex County (973) 218-6000
RICKERS & KULKARNI MEDICAL GROUP PA
Internal Medicine
116 MILLBURN AVE, SUITE 108
MILLBURN, NJ 07041
Essex County (973) 564-5227
DR. MEHUL N SHAH MD
Internal Medicine (Gastroenterology)
116 MILLBURN AVE, SUITE 214
MILLBURN, NJ 07041
Essex County (973) 378-2121
DR. TANDEEP K CHEEMA DDS
Dentist
116 MILLBURN AVE, SUITE 215
MILLBURN, NJ 07041
Essex County (516) 661-8071

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 Pratibha Kulkarni's NPI number?

The NPI number for Pratibha Kulkarni is 1306867478. It was assigned to this individual provider in the NPPES registry on July 22, 2006.

Where is Pratibha Kulkarni located?

Pratibha Kulkarni practices at 116 Millburn Ave Suite # 108, Millburn, NJ 07041. The listed phone number is (973) 564-5227.

What is Pratibha Kulkarni's specialty?

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

Is Pratibha Kulkarni enrolled in Medicare?

Yes. Pratibha Kulkarni is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Pratibha Kulkarni's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Pratibha Kulkarni reassigns Medicare benefits to Optum Medical Care Of New Jersey PC (New Hyde Park, NY). The 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 Pratibha Kulkarni's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Pratibha Kulkarni accept?

Health plans from Ambetter Health and Ambetter Health of Delaware list Pratibha Kulkarni 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.

When was this NPI record last updated?

The NPPES record for Pratibha Kulkarni was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.