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PUSHPA KHANAL M.D.
NPI 1972168367
Hospitalist in Rochester, NY

Active since May 01, 2019PECOS Enrolled
95.19/100
CMS Quality Rating
1425 PORTLAND AVE, ROCHESTER, NY 14621(585) 922-5027 Get Directions Write a Review

NPPES record last updated: October 21, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Oct 21, 2022, May 8, 2021, May 1, 2019 (3 updates tracked since 2019).

About Pushpa Khanal M.d. NPPES

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

PUSHPA KHANAL M.D. (NPI 1972168367) is an individual hospitalist provider in Rochester, New York, licensed in New York (319203) and active in the NPI registry since May 2019. She is enrolled in Medicare PECOS, is affiliated with Tanner Medical Center - Carrollton, and is a graduate of Other (2016).

NPPES Registry Identity

NPI1972168367
Entity TypeIndividualFemale
Primary Taxonomy208M00000X
Provider Legal NamePUSHPA KHANALCredential: M.D.
Location Address1425 PORTLAND AVERochester, NY 14621-3011
Mailing AddressOne Guthrie Square, Internal Medicine Residency GuthrieSayre, PA 18840 · (971) 706-8630
Phone(585) 922-5027
Sole ProprietorNo
Medical School CMSOtherGraduated 2016
Enumeration DateMay 1, 2019
Last NPPES UpdateOctober 21, 20223 updates tracked since enumeration
NPPES CertifiedOctober 21, 2022
✔ NPI 1972168367 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyHospitalistAllopathic & Osteopathic Physicians
Taxonomy Code208M00000X
License✔ Licensed in NY · 319203
Definition
Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients.
Also ListedInternal MedicineTaxonomy 207R00000X · License 319203 (NY)
1425 PORTLAND AVE, Rochester, NY 14621
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Oscar Insurance Company.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Pushpa Khanal M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9436527843
PECOS Enrollment IDI20230905000849
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.

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.
196 services86 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.
112 services48 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.
81 services81 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.
46 services46 patients
Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99231
Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.
38 services24 patients
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more 99308
A follow-up nursing facility visit per day is a daily check-up service provided by healthcare professionals. It lasts around 15 minutes and involves assessing your health status, monitoring your recovery progress, and addressing any concerns you may have about your health or treatment.
14 services12 patients

Hospital Affiliations CMS Care Compare 3

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

Tanner Medical Center - Carrollton

Acute Care Hospitals · Carrollton, GA
3/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number110011
Location705 Dixie StreetCarrollton, GA 30117 · Carroll County
Birthing friendly

Tanner Medical Center Villa Rica

Acute Care Hospitals · Villa Rica, GA
1/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number110015
Location601 Dallas HighwayVilla Rica, GA 30180 · Carroll County
Emergency services Birthing friendly

Higgins General Hospital

Critical Access Hospitals · Bremen, GA
OwnershipGovernment - Hospital District or Authority
CMS Certification Number111320
Location200 Allen Memorial DriveBremen, GA 30110 · Haralson County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 14621 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
$126.40 typical visit price
range $54.87 – $166.88
Typical copayment $31.60 (range $13.71 – $41.72)
Most-billed visit code 99204
Established Patient
$97.08 typical visit price
range $17.54 – $136.14
Typical copayment $24.27 (range $4.38 – $34.03)
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.

95.19/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality70.62
Promoting Interoperability100
Improvement Activities40

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.

DR. NIAZ AHMED D.D.S.
Dentist
1425 PORTLAND AVE
ROCHESTER, NY 14621
Monroe County (585) 922-4000
DR. BRIAN JOHN THOMAS D.O.
Anesthesiology
1425 PORTLAND AVE
ROCHESTER, NY 14621
Monroe County (585) 922-4159
LISA NICOLE FRONCZAK PA-C
Physician Assistant
1425 PORTLAND AVE, BOX 362
ROCHESTER, NY 14621
Monroe County (585) 922-4000
ANDREW ROTANDO DO
Emergency Medicine
1425 PORTLAND AVE
ROCHESTER, NY 14621
Monroe County (585) 922-3469
ALEXANDER VAZZANO MD
Emergency Medicine
1425 PORTLAND AVE
ROCHESTER, NY 14621
Monroe County (585) 922-4638
AMY BODROG MD
Internal Medicine (Hematology)
1425 PORTLAND AVE
ROCHESTER, NY 14621
Monroe County (585) 922-4020
NUMRA ASLAM BAJWA MD
Hospitalist
1425 PORTLAND AVE
ROCHESTER, NY 14621
Monroe County (585) 922-5067
DR. PRAKASH UPRETI MD
Hospitalist
1425 PORTLAND AVE
ROCHESTER, NY 14621
Monroe County (295) 029-8769

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 Pushpa Khanal's NPI number?

The NPI number for Pushpa Khanal is 1972168367. It was assigned to this individual provider in the NPPES registry on May 1, 2019.

Where is Pushpa Khanal located?

Pushpa Khanal practices at 1425 Portland Ave, Rochester, NY 14621. The listed phone number is (585) 922-5027.

What is Pushpa Khanal's specialty?

The primary specialty registered for this NPI is Hospitalist with taxonomy code 208M00000X.

Is Pushpa Khanal enrolled in Medicare?

Yes. Pushpa Khanal is registered in the Medicare PECOS enrollment system.

What insurance does Pushpa Khanal accept?

Health plans from Oscar Insurance Company list Pushpa Khanal 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 Pushpa Khanal affiliated with any hospitals?

According to CMS data, Pushpa Khanal is affiliated with Tanner Medical Center - Carrollton, Tanner Medical Center Villa Rica and Higgins General Hospital.

When was this NPI record last updated?

The NPPES record for Pushpa Khanal was last updated on October 21, 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.