PRASHANT K UPADHYAYA MD
NPI 1861699506
Surgery - Plastic and Reconstructive Surgery in Round Rock, TX

Q: What is Prashant Upadhyaya's NPI number?

The NPI number for Prashant Upadhyaya is 1861699506. It was assigned to this individual provider in the NPPES registry on June 27, 2007.

Q: What is Prashant Upadhyaya's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Plastic and Reconstructive Surgery, with taxonomy code 2086S0122X.

Active since June 27, 2007PECOS EnrolledAccepts Medicare Assignment

72.52/100

CMS Quality Rating

301 SETON PKWY STE 103, ROUND ROCK, TX 78665(512) 324-4815 Get Directions Write a Review

NPPES record last updated: August 25, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Aug 25, 2022, Mar 10, 2022 (2 updates tracked since 2022).

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About Prashant K Upadhyaya Md NPPES

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

PRASHANT K UPADHYAYA MD (NPI 1861699506) is an individual plastic and reconstructive surgery provider in Round Rock, Texas, licensed in Texas (P4722) and active in the NPI registry since June 2007. He is enrolled in Medicare PECOS, is affiliated with Ascension Seton Williamson, and is a graduate of Other (2001).

NPPES Registry Identity

NPI1861699506

Entity TypeIndividualMale

Primary Taxonomy2086S0122X

Provider Legal NamePRASHANT K UPADHYAYACredential: MD

Location Address301 SETON PKWY STE 103Round Rock, TX 78665-8003

Mailing Address301 Seton Pkwy Ste 103Round Rock, TX 78665-8003

Phone(512) 324-4815

Sole ProprietorNo

Medical School CMSOtherGraduated 2001

Enumeration DateJune 27, 2007

Last NPPES UpdateAugust 25, 20222 updates tracked since enumeration

NPPES CertifiedAugust 25, 2022

✔ NPI 1861699506 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtySurgery · Plastic and Reconstructive SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code2086S0122X

Licenses✔ Licensed in TX · P4722✔ Licensed in NY · 269241

Definition

A surgeon who specializes in plastic and reconstructive surgery.

Also ListedPlastic Surgery · Surgery of the HandTaxonomy 2082S0105X · License 269241 (NY)

Also ListedSurgeryTaxonomy 208600000X · License 269241 (NY), 5159 (NE)

301 SETON PKWY STE 103, Round Rock, TX 78665

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Other Identifiers 1

Medicaid03586041NY

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas, Oscar Insurance Company, Sendero Health Plans, Local Nonprofit.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

Prashant K Upadhyaya 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 ID244465045

PECOS Enrollment IDI20220808003319

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 3

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.

Creation of muscle graft to trunk 15734

The creation of a muscle graft to the trunk is a surgical procedure where healthy muscle tissue is moved from one part of the body to another. This helps to repair damaged areas, improve function, and enhance appearance. It's a common procedure in reconstructive surgery.

19 services11 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

13 services13 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

12 services12 patients

Hospital Affiliations CMS Care Compare

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

Ascension Seton Williamson

Acute Care Hospitals · Round Rock, TX

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number670041

Location201 Seton ParkwayRound Rock, TX 78664 · Williamson 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.

72.52/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

61.27

Promoting Interoperability

100

Improvement Activities

Cost

47.12

Reported Quality Measures

Breast Cancer Screening

54%81 patients3/55-star benchmark: 93%

Cervical Cancer Screening

17%136 patients1/55-star benchmark: 98%

Colorectal Cancer Screening

28%135 patients2/55-star benchmark: 88%

Controlling High Blood Pressure

62%34 patients3/55-star benchmark: 91%

Diabetes: Eye Exam

15%20 patients1/55-star benchmark: 100%

Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)

Lower rates are better for this measure.

75%20 patients2/55-star benchmark: 91%

Documentation of Current Medications in the Medical Record

79%290 patients3/55-star benchmark: 100%

Falls: Screening for Future Fall Risk

23%40 patients1/55-star benchmark: 100%

HIV Screening

4%202 patients1/55-star benchmark: 60%

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

22%227 patients1/55-star benchmark: 98%

Preventive Care and Screening: Screening for Depression and Follow-Up Plan

17%199 patients1/55-star benchmark: 97%

Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

33%231 patients3/55-star benchmark: 61%

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Patients screened: 35% · 184 patients

33%184 patients

Provide Patients Electronic Access to Their Health Information

84%205 patients4/55-star benchmark: 100%

Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

66%35 patients3/55-star benchmark: 91%

Use of High-Risk Medications in Older Adults

Lower rates are better for this measure.

Patients appropriateDiagnosis: 0% · 47 patients

Patients totalRate: 9% · 47 patients

9%47 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 2

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

SARAH REED PA-C

Physician Assistant

301 SETON PKWY STE 103
ROUND ROCK, TX 78665

Williamson County (512) 324-4815

BENJAMIN YARBROUGH M.D.

Surgery (Plastic and Reconstructive Surgery)

301 SETON PKWY STE 103
ROUND ROCK, TX 78665

Williamson County (512) 324-4815

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 Prashant Upadhyaya's NPI number?

The NPI number for Prashant Upadhyaya is 1861699506. It was assigned to this individual provider in the NPPES registry on June 27, 2007.

Where is Prashant Upadhyaya located?

Prashant Upadhyaya practices at 301 Seton Pkwy Ste 103, Round Rock, TX 78665. The listed phone number is (512) 324-4815.

What is Prashant Upadhyaya's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Plastic and Reconstructive Surgery, with taxonomy code 2086S0122X.

Is Prashant Upadhyaya enrolled in Medicare?

Yes. Prashant Upadhyaya 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 Prashant Upadhyaya accept?

Health plans from Blue Cross and Blue Shield of Texas, Oscar Insurance Company and Sendero Health Plans, Local Nonprofit list Prashant Upadhyaya 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 Prashant Upadhyaya affiliated with any hospitals?

According to CMS data, Prashant Upadhyaya is affiliated with Ascension Seton Williamson.

When was this NPI record last updated?

The NPPES record for Prashant Upadhyaya was last updated on August 25, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.