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PRACHI NILESH PATHAK O. D.
NPI 1952605743
Optometrist in Dover, DE

Active since January 07, 2011PECOS EnrolledAccepts Medicare Assignment
89.38/100
CMS Quality Rating
885 S GOVERNORS AVE, DOVER, DE 19904(302) 734-5861(302) 734-1921 Get Directions Write a Review

NPPES record last updated: June 23, 2011. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Prachi Nilesh Pathak O. D. NPPES

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

PRACHI NILESH PATHAK O. D. (NPI 1952605743) is an individual optometrist in Dover, Delaware, licensed in Delaware (I3-0001350) and active in the NPI registry since January 2011. She is enrolled in Medicare PECOS and is a graduate of New England College Of Optometry (2010).

NPPES Registry Identity

NPI1952605743
Entity TypeIndividualFemale
Primary Taxonomy152W00000X
Provider Legal NamePRACHI NILESH PATHAKCredential: O. D.
Location Address885 S GOVERNORS AVEDover, DE 19904-4158
Mailing Address885 S Governors AveDover, DE 19904-4158 · (302) 734-5861 · Fax (302) 734-1921
Phone(302) 734-5861
Fax(302) 734-1921
Sole ProprietorNo
Medical School CMSNew England College Of OptometryGraduated 2010
Enumeration DateJanuary 7, 2011
Last NPPES UpdateJune 23, 2011
✔ NPI 1952605743 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
Licenses✔ Licensed in DE · I3-0001350✔ Licensed in DE · I4-0000054
Definition
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
885 S GOVERNORS AVE, Dover, DE 19904
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Other Identifiers 9

Other12186947Caqh
OtherI3-0001350DE · De-permanent License Eff 02072011
Other803261H47Medicare Ptan Halpern Medical Services
Other1952605743Indiviual Npi
Other1346430360DE · Halpern Opthamology Asso Group Npi
OtherG00016DE · Halpern Eye Asso Group Medicare
Other803261H16Medicare Ptan Hea
Other1245251313DE · Halpern Eye Associates Group Npi
OtherG01047DE · Halpern Opthamology Asso Group Medicare Id

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter from NH Healthy Families, Ambetter from Sunflower Health Plan and more.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

Prachi Nilesh Pathak O. 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 ID7113105198
PECOS Enrollment IDI20110621000728
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 6

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.

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.
136 services127 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
53 services45 patients
Imaging of retina 92134
Imaging of the retina is a non-invasive procedure that captures detailed images of your eye's interior. This helps detect conditions like macular degeneration or retinal detachment. It's painless and takes only a few minutes.
45 services42 patients
Exam of visual field with extended testing 92083
An extended visual field exam is a detailed test to evaluate your peripheral (side) vision. It helps to detect any potential blind spots which may not be noticeable in daily life. These could be caused by eye diseases like glaucoma, or neurological conditions.
43 services37 patients
Imaging of optic nerve 92133
Imaging of the optic nerve is a non-invasive procedure that captures detailed pictures of your optic nerve. It helps doctors assess eye health, particularly for conditions like glaucoma. It's painless, quick, and uses safe technology like MRI or OCT (Optical Coherence Tomography).
43 services33 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.
21 services21 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19904 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
$131.15 typical visit price
range $57.12 – $173.08
Typical copayment $32.78 (range $14.28 – $43.27)
Most-billed visit code 99204
Established Patient
$71.19 typical visit price
range $18.36 – $141.05
Typical copayment $17.79 (range $4.59 – $35.26)
Most-billed visit code 99213
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.

89.38/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality100
Improvement Activities40
Cost64.6

Other Providers at the Same Location NPPES 12

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

HALPERN EYE ASSOCIATES, P. A.
Optometrist
885 S GOVERNORS AVE
DOVER, DE 19904
Kent County (302) 734-5861
PRITI V PATEL OD
Optometrist
885 S GOVERNORS AVE
DOVER, DE 19904
Kent County (302) 734-5861
DR. PATRICIA LYNN SPARKS O.D.
Optometrist
885 S GOVERNORS AVE
DOVER, DE 19904
Kent County (302) 734-5861
MYEYEDR OPTOMETRY OF DELAWARE PA
Optometrist
885 S GOVERNORS AVE
DOVER, DE 19904
Kent County (302) 734-5861
DENNIS R MIRRA O. D.
Optometrist
885 S GOVERNORS AVE
DOVER, DE 19904
Kent County (302) 734-5861
HALPERN EYE ASSOCIATES, P. A.
Eyewear Supplier
885 S GOVERNORS AVE
DOVER, DE 19904
Kent County (302) 734-5861
TROY D RABER O. D.
Optometrist
885 S GOVERNORS AVE
DOVER, DE 19904
Kent County (302) 734-5861
TIMOTHY JOHN SMITH O.D.
Optometrist
885 S GOVERNORS AVE
DOVER, DE 19904
Kent County (302) 734-1472

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 Prachi Pathak's NPI number?

The NPI number for Prachi Pathak is 1952605743. It was assigned to this individual provider in the NPPES registry on January 7, 2011.

Where is Prachi Pathak located?

Prachi Pathak practices at 885 S Governors Ave, Dover, DE 19904. The listed phone number is (302) 734-5861.

What is Prachi Pathak's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Prachi Pathak enrolled in Medicare?

Yes. Prachi Pathak 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 Prachi Pathak accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Home State Health, Ambetter from NH Healthy Families and Ambetter from Sunflower Health Plan and 7 other insurers list Prachi Pathak 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 Prachi Pathak was last updated on June 23, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.