Active NPI 1346231263 Individual Practitioner Female Practitioner

Dr. Pratibha P Rao , MD

General Practice • Montclair, NJ

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Pratibha Rao, MD is a certified General Practice practicing in Montclair, NJ. With approximately 32 years of clinical experience since completing medical education in 1994, Dr. Rao delivers high-quality medical care to the local community at 1 BAY AVE.

Dr. Rao is affiliated with Valley Physician Services Pc and accepts Medicare assignment.

Frequently performed procedures and clinical services include subsequent hospital care with moderate levelof medical decision making, if using time, at least, initial hospital care with straightforward or low-level medical decision making, if using time, at least, hospital discharge day management, more than. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1 Bay Ave

Montclair, NJ 070424837

Telephone 9734296000

Associated Practice Facility / Clinic

🏢 Evergreen Emergency Solutions, Pc Facility NPI 1558349274

Medicare Profile & Education

Medical School

Other

Graduation Year

1994

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Montclair, NJ

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

32 Yrs +8.0 yrs vs City Avg

City Avg: 24.0 Yrs

State Avg: 26.1 Yrs

Regional Practice Density

2 Specialists

Practicing in Montclair, NJ (269 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

68.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Rao (32 Years) 32 Yrs

Montclair Specialty Average (24.0 Years) 24.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	398	211	$257.00	$86.71
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	225	225	$485.00	$144.67
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	122	90	$368.00	$129.70
99239 Hospital discharge day management, more than 30 minutes	118	117	$383.00	$127.34
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	112	110	$717.00	$190.57
99238 Hospital discharge day management, 30 minutes or less	49	49	$261.00	$91.18
99231 Follow-up hospital inpatient care per day, typically 15 minutes	41	27	$139.00	$54.98

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	237	125	$257.00	$85.29
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	218	216	$485.00	$140.46
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	215	208	$717.00	$185.63
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	74	63	$368.00	$130.05
99239 Hospital discharge day management, more than 30 minutes	72	69	$383.00	$123.59
99231 Follow-up hospital inpatient care per day, typically 15 minutes	44	28	$139.00	$54.16
99238 Hospital discharge day management, 30 minutes or less	19	19	$261.00	$88.95

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	159	96	$257.00	$77.67
99220 Hospital observation care, typically 70 minutes	139	138	$657.00	$191.98
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	124	122	$717.00	$214.10
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	122	88	$368.00	$109.36
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	53	53	$485.00	$144.49
99219 Hospital observation care, typically 50 minutes	49	49	$481.00	$143.93
99239 Hospital discharge day management, more than 30 minutes	33	33	$383.00	$113.27
99217 Hospital observation care on day of discharge	27	27	$261.00	$79.22
99226 Subsequent observation care, typically 35 minutes per day	27	25	$371.00	$110.62
99231 Follow-up hospital inpatient care per day, typically 15 minutes	19	14	$139.00	$41.97
99225 Subsequent observation care, typically 25 minutes per day	15	12	$259.00	$77.62
99238 Hospital discharge day management, 30 minutes or less	13	13	$261.00	$79.07

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	256	249	$717.00	$215.78
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	143	78	$257.00	$77.25
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	112	112	$485.00	$147.93
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	108	77	$368.00	$112.48
99220 Hospital observation care, typically 70 minutes	81	81	$657.00	$194.99
99219 Hospital observation care, typically 50 minutes	37	36	$481.00	$147.51
99239 Hospital discharge day management, more than 30 minutes	35	35	$383.00	$117.91
99217 Hospital observation care on day of discharge	15	15	$261.00	$80.11
99226 Subsequent observation care, typically 35 minutes per day	13	11	$371.00	$113.53

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	294	152	$257.00	$77.54
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	207	145	$368.00	$112.14
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	117	112	$717.00	$222.70
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	82	81	$485.00	$151.02
99239 Hospital discharge day management, more than 30 minutes	53	53	$383.00	$117.17
99231 Follow-up hospital inpatient care per day, typically 15 minutes	36	25	$139.00	$42.55
99238 Hospital discharge day management, 30 minutes or less	31	31	$261.00	$81.57
99217 Hospital observation care on day of discharge	16	16	$261.00	$81.31
99225 Subsequent observation care, typically 25 minutes per day	12	11	$259.00	$80.62
99220 Hospital observation care, typically 70 minutes	11	11	$657.00	$205.12
99219 Hospital observation care, typically 50 minutes	11	11	$481.00	$151.10

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	469	213	$222.60	$78.79
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	284	174	$279.10	$111.28
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	111	108	$541.79	$217.15
99238 Hospital discharge day management, 30 minutes or less	100	99	$192.69	$79.05
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	73	73	$333.77	$146.25
99239 Hospital discharge day management, more than 30 minutes	55	55	$287.51	$117.02
99231 Follow-up hospital inpatient care per day, typically 15 minutes	34	22	$105.00	$42.58
99217 Hospital observation care on day of discharge	29	29	$192.00	$71.65
99225 Subsequent observation care, typically 25 minutes per day	15	12	$200.93	$79.21

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	428	211	$220.00	$77.74
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	426	245	$272.00	$109.65
99239 Hospital discharge day management, more than 30 minutes	77	76	$282.00	$112.23
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	71	70	$530.00	$215.46
99238 Hospital discharge day management, 30 minutes or less	64	63	$192.00	$78.33
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	54	54	$325.00	$147.19
99231 Follow-up hospital inpatient care per day, typically 15 minutes	40	21	$105.00	$42.14
99217 Hospital observation care on day of discharge	25	25	$192.00	$73.09
99225 Subsequent observation care, typically 25 minutes per day	19	17	$192.00	$78.91
99219 Hospital observation care, typically 50 minutes	14	14	$352.00	$136.04

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	588	262	$220.00	$77.49
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	354	247	$275.22	$111.48
99239 Hospital discharge day management, more than 30 minutes	106	105	$282.00	$114.48
99238 Hospital discharge day management, 30 minutes or less	93	92	$192.00	$78.72
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	81	79	$530.00	$217.66
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	66	66	$325.00	$143.48
99231 Follow-up hospital inpatient care per day, typically 15 minutes	51	32	$105.00	$42.18
99217 Hospital observation care on day of discharge	32	32	$192.00	$76.66
99225 Subsequent observation care, typically 25 minutes per day	14	13	$192.00	$73.00

Medical Specialties & State Licenses

General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License NJ 25MA07823300

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Internal Medicine

NUCC Taxonomy Code: 207R00000X

State License NJ 25MA07823300

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Hospitalist

NUCC Taxonomy Code: 208M00000X

State License NJ 25MA07823300

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.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

0075825 (NJ)

Hospital & Practice Group Affiliations

Valley Physician Services Pc

108 Jackson St, Hoboken, NJ 070306101

Phone: 8008255391

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners

Michelle Harney , LCSW

Social Worker - Clinical

NPI 1013266725

Licensed Clinical Social Worker

Yelena Berlin

Physician Assistant

NPI 1033383823

Valentina Kolker , RPA-C

Physician Assistant - Surgical

NPI 1033431960

RPAC

Barry Benzing , PA-C

Physician Assistant

NPI 1063969467

Physician Assistant (Certified)

Dr. Christina Huynh , MD

Student in an Organized Health Care Education/Training Program

NPI 1073176913

Doctor of Medicine (M.D.)

Dr. Brendan Stanzione , PT, DPT

Physical Therapist

NPI 1083485452

Physical Therapist, Doctor of Physical Therapy

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍

Updated Practice Location July 08, 2007

Registered at 1 BAY AVE, MONTCLAIR, NJ 070424837 (Tel: 9734296000)

📍

Updated Business Mailing Address July 08, 2007

Registered at 66 WEST GILBERT STREET, RED BANK, NJ 077014918 (Tel: 7322120060)

👤

Provider Name / Credentials Updated July 08, 2007

Recorded as PRATIBHA RAO, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Internal Medicine (License #25MA07823300 in NJ)

🟢

Initial NPI Registration & Enumeration October 31, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

0 Reviews

No patient reviews submitted yet for Dr. Pratibha Rao. Be the first to share your experience!

Only verified registered users can submit ratings, post feedback, and upload facility photos.

NPI Administrative Meta

NPI Number: 1346231263

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: October 31, 2005

Last Update: July 13, 2026

Sole Proprietor: No

Update or Correct Profile

Mailing Address

66 West Gilbert Street

Red Bank, NJ 077014918

Phone: 7322120060

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.