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PRATIMA VIJAY KUMAR MD
NPI 1972558658
Internal Medicine - Endocrinology, Diabetes & Metabolism in Austin, TX

Active since May 23, 2006PECOS EnrolledAccepts Medicare Assignment
72.52/100
CMS Quality Rating
601 E 15TH ST, AUSTIN, TX 78701(512) 324-7000(512) 324-8021 Get Directions Write a Review

NPPES record last updated: November 26, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Pratima Vijay Kumar Md NPPES

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

PRATIMA VIJAY KUMAR MD (NPI 1972558658) is an individual endocrinology, diabetes & metabolism provider in Austin, Texas, licensed in Texas (K8781) and active in the NPI registry since May 2006. She is enrolled in Medicare PECOS, is affiliated with Ascension Seton Medical Center Austin, and is a graduate of Other (1995).

NPPES Registry Identity

NPI1972558658
Entity TypeIndividualFemale
Primary Taxonomy207RE0101X
Provider Legal NamePRATIMA VIJAY KUMARCredential: MD
Location Address601 E 15TH STAustin, TX 78701-1930
Mailing Address601 E 15th StAustin, TX 78701-1930 · (512) 324-7000 · Fax (512) 324-8021
Phone(512) 324-7000
Fax(512) 324-8021
Sole ProprietorNo
Medical School CMSOtherGraduated 1995
Enumeration DateMay 23, 2006
Last NPPES UpdateNovember 26, 2012
✔ NPI 1972558658 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Endocrinology, Diabetes & MetabolismAllopathic & Osteopathic Physicians
Taxonomy Code207RE0101X
License✔ Licensed in TX · K8781
Definition
An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems.
601 E 15TH ST, Austin, TX 78701
Open in Google Maps ↗

Other Names 1

Former Name (1)Pratima Singh

Other Identifiers 3

Medicare UPINH04547
Medicaid031063304TX
Medicare PINTXB100486

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections 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

Pratima Vijay Kumar 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 ID5890750939
PECOS Enrollment IDI20050225000615
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 4

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.
48 services35 patients
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
29 services22 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.
27 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.
18 services18 patients

Hospital Affiliations CMS Care Compare 2

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

Ascension Seton Medical Center Austin

Acute Care Hospitals · Austin, TX
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number450056
Location1201 W 38th StAustin, TX 78705 · Travis County
Emergency services Birthing friendly

Dell Seton Med Center At The University Of Tx

Acute Care Hospitals · Austin, TX
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number450124
Location601 E 15th StreetAustin, TX 78701 · Travis County

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 78701 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
$131.95 typical visit price
range $57.88 – $174.00
Typical copayment $32.98 (range $14.47 – $43.50)
Most-billed visit code 99204
Established Patient
$101.65 typical visit price
range $18.88 – $142.23
Typical copayment $25.41 (range $4.72 – $35.55)
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.

72.52/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality61.27
Promoting Interoperability100
Improvement Activities40
Cost47.12

Reported Quality Measures

Breast Cancer Screening
57%165 patients3/55-star benchmark: 93%
Cervical Cancer Screening
45%225 patients2/55-star benchmark: 98%
Closing the Referral Loop: Receipt of Specialist Report
45%122 patients3/55-star benchmark: 87%
Colorectal Cancer Screening
49%289 patients3/55-star benchmark: 88%
Controlling High Blood Pressure
70%158 patients4/55-star benchmark: 91%
Diabetes: Eye Exam
15%179 patients1/55-star benchmark: 100%
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
Lower rates are better for this measure.
30%179 patients4/55-star benchmark: 91%
Documentation of Current Medications in the Medical Record
94%1,018 patients4/55-star benchmark: 100%
e-Prescribing
95%365 patients3/55-star benchmark: 100%
Falls: Screening for Future Fall Risk
19%182 patients1/55-star benchmark: 100%
HIV Screening
12%395 patients1/55-star benchmark: 60%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
35%363 patients2/55-star benchmark: 98%
Preventive Care and Screening: Screening for Depression and Follow-Up Plan
27%430 patients2/55-star benchmark: 97%
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
33%367 patients3/55-star benchmark: 61%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Patients combinedPopulations: 55% · 430 patients
Patients screened: 57% · 430 patients
71%21 patients3/55-star benchmark: 100%
Provide Patients Electronic Access to Their Health Information
97%230 patients4/55-star benchmark: 100%
Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
80%205 patients4/55-star benchmark: 91%
Use of High-Risk Medications in Older Adults
Lower rates are better for this measure.
Patients appropriateDiagnosis: 1% · 185 patients
Patients totalRate: 4% · 190 patients
5%190 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.

Referred Medical Equipment & Supplies CMS DME claims

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

Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
10 suppliers112 claims116 services$185.30 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.

PREETI VENKATRAMAN M.B.B.S.
Hospitalist
601 E 15TH ST
AUSTIN, TX 78701
Travis County (512) 324-7000
DR. CHAD ALAN HOOTEN MD
Psychiatry & Neurology (Psychiatry)
601 E 15TH ST
AUSTIN, TX 78701
Travis County (512) 324-2000
SETON HOSPITALIST SERVICE
Internal Medicine
601 E 15TH ST
AUSTIN, TX 78701
Travis County (512) 324-7000
DR. JOHN EDWARD MORAN III M.D.
Internal Medicine
601 E 15TH ST, UT DELL MEDICAL SCHOOL INTERNAL MEDICINE
AUSTIN, TX 78701
Travis County (512) 324-7000
CHRISTOPHER ZIEBELL M.D.
Emergency Medicine (Emergency Medical Services)
601 E 15TH ST
AUSTIN, TX 78701
Travis County (512) 324-7030
SARAH EGGERS ACNS-BC
Clinical Nurse Specialist (Adult Health)
601 E 15TH ST
AUSTIN, TX 78701
Travis County (512) 324-8933
BCEP, PA
Emergency Medicine
601 E 15TH ST
AUSTIN, TX 78701
Travis County (512) 324-7000
MR. TRAVIS PIPKIN N.P.
Nurse Practitioner
601 E 15TH ST
AUSTIN, TX 78701
Travis County (512) 324-7000

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 Pratima Kumar's NPI number?

The NPI number for Pratima Kumar is 1972558658. It was assigned to this individual provider in the NPPES registry on May 23, 2006. The provider is also known as Pratima Singh.

Where is Pratima Kumar located?

Pratima Kumar practices at 601 E 15th St, Austin, TX 78701. The listed phone number is (512) 324-7000.

What is Pratima Kumar's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Endocrinology, Diabetes & Metabolism, with taxonomy code 207RE0101X.

Is Pratima Kumar enrolled in Medicare?

Yes. Pratima Kumar 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 Pratima Kumar accept?

Health plans from Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 4 other insurers list Pratima Kumar 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 Pratima Kumar affiliated with any hospitals?

According to CMS data, Pratima Kumar is affiliated with Ascension Seton Medical Center Austin and Dell Seton Med Center At The University Of Tx.

When was this NPI record last updated?

The NPPES record for Pratima Kumar was last updated on November 26, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.