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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

DR. PRATIBHA P RAO MD
NPI 1346231263
General Practice in Montclair, NJ

Active since October 31, 2005PECOS Enrolled
98.67/100
CMS Quality Rating
1 BAY AVE, MONTCLAIR, NJ 07042(973) 429-6000 Get Directions Write a Review

NPPES record last updated: July 13, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 13, 2026, Sep 11, 2025 (2 updates tracked since 2025).

About Dr. Pratibha P Rao Md NPPES

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

DR. PRATIBHA P RAO MD (NPI 1346231263) is an individual general practice provider in Montclair, New Jersey, licensed in New Jersey (25MA07823300) and active in the NPI registry since October 2005. She is enrolled in Medicare PECOS, is affiliated with Valley Hospital, and is a graduate of Other (1994).

NPPES Registry Identity

NPI1346231263
Entity TypeIndividualFemale
Primary Taxonomy208D00000X
Provider Legal NameDR. PRATIBHA P RAOCredential: MD
Location Address1 BAY AVEMontclair, NJ 07042-4837
Mailing Address66 West Gilbert StreetRed Bank, NJ 07701-4918 · (732) 212-0060
Phone(973) 429-6000
Sole ProprietorNo
Medical School CMSOtherGraduated 1994
Enumeration DateOctober 31, 2005
Last NPPES UpdateJuly 13, 20262 updates tracked since enumeration
✔ NPI 1346231263 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
License✔ Licensed in NJ · 25MA07823300
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedInternal MedicineTaxonomy 207R00000X · License 25MA07823300 (NJ)
Also ListedHospitalistTaxonomy 208M00000X · License 25MA07823300 (NJ)
1 BAY AVE, Montclair, NJ 07042
Open in Google Maps ↗

Other Identifiers 1

Medicaid0075825NJ

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

Dr. Pratibha P Rao Md 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 ID2264462662
PECOS Enrollment IDI20050824000839
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 7

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 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.
398 services211 patients
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
225 services225 patients
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.
122 services90 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.
118 services117 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.
112 services110 patients
Hospital discharge day management, 30 minutes or less 99238
Hospital discharge day management of 30 minutes or less includes finalizing your treatment, discussing your progress, and planning after-care at home. It ensures you're ready to leave the hospital and continue recovery safely.
49 services49 patients

Hospital Affiliations CMS Care Compare

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

Valley Hospital

Acute Care Hospitals · Paramus, NJ
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number310012
Location4 Valley Health PlazaParamus, NJ 07652 · Bergen County
Emergency services Birthing friendly

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.

98.67/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality93.57
Promoting Interoperability100
Improvement Activities40

Referred Medical Equipment & Supplies CMS DME claims 2

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

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431
DME-Oxygen and Supplies · category DC000N
1 supplier13 claims13 services$14.84 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
1 supplier13 claims13 services$66.80 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.

SAMRAH GHANI MD
Student in an Organized Health Care Education/Training Program
1 BAY AVE
MONTCLAIR, NJ 07042
Essex County (862) 333-4700
JACLYN TAYLOR SCHMITZ
Student in an Organized Health Care Education/Training Program
1 BAY AVE
MONTCLAIR, NJ 07042
Essex County (973) 429-6888
MYINT KYI M.D.
Anesthesiology
1 BAY AVE
MONTCLAIR, NJ 07042
Essex County (973) 429-6219
EDWARD PETRARCA LCSW
Social Worker (Clinical)
1 BAY AVE, MOUNTAINSIDE HOSPITAL
MONTCLAIR, NJ 07042
Essex County (973) 429-6813
ANN FRANCES VALLONE NURSE PRACTITIONER
Nurse Practitioner (Adult Health)
1 BAY AVE
MONTCLAIR, NJ 07042
Essex County (973) 429-6272
ANN SAMIR YASIN IBRAHIM
Student in an Organized Health Care Education/Training Program
1 BAY AVE
MONTCLAIR, NJ 07042
Essex County (862) 333-4700
GEORGE JAMES ZACH
Dentist
1 BAY AVE
MONTCLAIR, NJ 07042
Essex County (973) 429-6888
MRS. ESTHER D. BAXAM-SPENCE RN, MSN, CNNP
Nurse Practitioner (Neonatal)
1 BAY AVE
MONTCLAIR, NJ 07042
Essex County (973) 429-6991

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 Rao's NPI number?

The NPI number for Pratibha Rao is 1346231263. It was assigned to this individual provider in the NPPES registry on October 31, 2005.

Where is Pratibha Rao located?

Pratibha Rao practices at 1 Bay Ave, Montclair, NJ 07042. The listed phone number is (973) 429-6000.

What is Pratibha Rao's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Pratibha Rao enrolled in Medicare?

Yes. Pratibha Rao 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.

Is Pratibha Rao affiliated with any hospitals?

According to CMS data, Pratibha Rao is affiliated with Valley Hospital.

When was this NPI record last updated?

The NPPES record for Pratibha Rao was last updated on July 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 35 days 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.