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DR. AJAY S RATHORE M.D.
NPI 1023372679
Internal Medicine - Nephrology in Newport News, VA

Active since June 28, 2012PECOS EnrolledAccepts Medicare Assignment
94.07/100
CMS Quality Rating
739 THIMBLE SHOALS BLVD, NEWPORT NEWS, VA 23606(757) 873-1009(757) 873-7689 Get Directions Write a Review

NPPES record last updated: December 8, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 8, 2017, Nov 2, 2017 (2 updates tracked since 2017).

About Dr. Ajay S Rathore M.d. NPPES

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

DR. AJAY S RATHORE M.D. (NPI 1023372679) is an individual nephrology provider in Newport News, Virginia, licensed in Virginia (0101261994) and active in the NPI registry since June 2012. He is enrolled in Medicare PECOS, is affiliated with Riverside Regional Medical Center, and is a graduate of Other (1999).

NPPES Registry Identity

NPI1023372679
Entity TypeIndividualMale
Primary Taxonomy207RN0300X
Provider Legal NameDR. AJAY S RATHORECredential: M.D.
Location Address739 THIMBLE SHOALS BLVDNewport News, VA 23606-3562
Mailing Address856 J Clyde Morris Blvd Ste ANewport News, VA 23601-1318 · (757) 316-5800 · Fax (757) 534-5190
Phone(757) 873-1009
Fax(757) 873-7689
Sole ProprietorYes
Medical School CMSOtherGraduated 1999
Enumeration DateJune 28, 2012
Last NPPES UpdateDecember 8, 20172 updates tracked since enumeration
✔ NPI 1023372679 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · NephrologyAllopathic & Osteopathic Physicians
Taxonomy Code207RN0300X
License✔ Licensed in VA · 0101261994
Definition
An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.
739 THIMBLE SHOALS BLVD, Newport News, VA 23606
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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

Dr. Ajay S Rathore M.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 ID3577834993
PECOS Enrollment IDI20170803001663
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 10

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.
225 services113 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.
189 services74 patients
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.
179 services72 patients
Dialysis services, 4 or more physician visits per month (20 years or older) 90960
Dialysis is a treatment that filters and purifies your blood using a machine. It helps keep your fluids and electrolytes in balance when the kidneys can't do their job. This service includes 4 or more visits per month with a physician to monitor your health and adjust your treatment as needed.
140 services59 patients
Critical care, first 30-74 minutes 99291
Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.
108 services48 patients
Home dialysis services per month (20 years or older) 90966
Home dialysis services provide kidney treatment for patients aged 20 or older right in their own homes. This service includes necessary equipment, supplies, and support for performing dialysis. It's a convenient option that allows patients to maintain their daily routines while receiving essential care.
55 services26 patients

Hospital Affiliations CMS Care Compare 2

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

Riverside Regional Medical Center

Acute Care Hospitals · Newport News, VA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number490052
Location500 J Clyde Morris BlvdNewport News, VA 23601 · Newport News City County
Emergency services Birthing friendly

Riverside Doctors' Hospital Of Williamsburg

Acute Care Hospitals · Williamsburg, VA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number490143
Location1500 Commonwealth AvenueWilliamsburg, VA 23185 · James City County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 23606 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
$129.04 typical visit price
range $56.19 – $170.30
Typical copayment $32.26 (range $14.04 – $42.57)
Most-billed visit code 99204
Established Patient
$99.13 typical visit price
range $18.07 – $138.91
Typical copayment $24.78 (range $4.51 – $34.72)
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.

94.07/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality90.65
Promoting Interoperability95.83
Improvement Activities40

Referred Medical Equipment & Supplies CMS DME claims 5

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

Azathioprine, oral, 50 mg J7500
Treatment-Treatment - Miscellaneous · category RX029N
1 supplier11 claims660 services$1.03 avg. paid by Medicare
Cyclosporine, oral, 25 mg J7515
Treatment-Treatment - Miscellaneous · category RX029N
1 supplier11 claims1,980 services$0.59 avg. paid by Medicare
Mycophenolate mofetil, oral, 250 mg J7517
Treatment-Treatment - Miscellaneous · category RX029N
2 suppliers13 claims1,140 services$0.17 avg. paid by Medicare
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period Q0511
Treatment-Chemotherapy · category RH012N
3 suppliers20 claims20 services$17.05 avg. paid by Medicare
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period Q0512
Treatment-Chemotherapy · category RH012N
3 suppliers21 claims21 services$12.63 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.

HOLLI ELIZABETH BRILEY
Behavior Technician
739 THIMBLE SHOALS BLVD
NEWPORT NEWS, VA 23606
Newport News City (757) 690-9390
REBECCA DAVIDSON MSW
Social Worker (Clinical)
739 THIMBLE SHOALS BLVD, 400
NEWPORT NEWS, VA 23606
Newport News City (757) 838-1960
NEW DIRECTIONS FOR BROKEN FAMILIES
Community/Behavioral Health
739 THIMBLE SHOALS BLVD, SUITE 1011-B
NEWPORT NEWS, VA 23606
Newport News City (804) 616-6923
RIVERSIDE PHYSICIAN SERVICES INC
Internal Medicine (Nephrology)
739 THIMBLE SHOALS BLVD, SUITE 801
NEWPORT NEWS, VA 23606
Newport News City (757) 873-1009
JESSICA WHITE LPC RESIDENT
Counselor (Professional)
739 THIMBLE SHOALS BLVD, #400
NEWPORT NEWS, VA 23606
Newport News City (757) 838-1960
CHARISE PEARSON LPC
Counselor (Professional)
739 THIMBLE SHOALS BLVD, STE 400
NEWPORT NEWS, VA 23606
Newport News City (757) 838-1960
PENINSULA AGENCY ON AGING
Case Management
739 THIMBLE SHOALS BLVD, BUILDING 1000, STE 1006
NEWPORT NEWS, VA 23606
Newport News City (757) 873-0541
KELLI WILLSHIRE LCSW
Counselor (Professional)
739 THIMBLE SHOALS BLVD, STE 400
NEWPORT NEWS, VA 23606
Newport News City (757) 838-1960

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 Ajay Rathore's NPI number?

The NPI number for Ajay Rathore is 1023372679. It was assigned to this individual provider in the NPPES registry on June 28, 2012.

Where is Ajay Rathore located?

Ajay Rathore practices at 739 Thimble Shoals Blvd, Newport News, VA 23606. The listed phone number is (757) 873-1009.

What is Ajay Rathore's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

Is Ajay Rathore enrolled in Medicare?

Yes. Ajay Rathore 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.

Is Ajay Rathore affiliated with any hospitals?

According to CMS data, Ajay Rathore is affiliated with Riverside Regional Medical Center and Riverside Doctors' Hospital Of Williamsburg.

When was this NPI record last updated?

The NPPES record for Ajay Rathore was last updated on December 8, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.