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PENNY RATHBURN DO
NPI 1063555944
Internal Medicine in Saint Joseph, MI

Active since February 14, 2007PECOS EnrolledAccepts Medicare Assignment
84.88/100
CMS Quality Rating
1234 NAPIER AVE, SAINT JOSEPH, MI 49085(269) 985-4632 Get Directions Write a Review

NPPES record last updated: October 14, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Penny Rathburn Do NPPES

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

PENNY RATHBURN DO (NPI 1063555944) is an individual internal medicine provider in Saint Joseph, Michigan, licensed in Michigan (5101013856) and active in the NPI registry since February 2007. She is enrolled in Medicare PECOS, is affiliated with Lakeland Hospital, St Joseph, and maintains a secondary practice location in Kalamazoo.

NPPES Registry Identity

NPI1063555944
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NamePENNY RATHBURNCredential: DO
Location Address1234 NAPIER AVESaint Joseph, MI 49085-2112
Mailing Address1234 Napier AveSaint Joseph, MI 49085-2112
Phone(269) 985-4632
Sole ProprietorNo
Medical School CMSDes Moines University Of Osteopathic Medicine And Health SciencesGraduated 1998
Enumeration DateFebruary 14, 2007
Last NPPES UpdateOctober 14, 2024
NPPES CertifiedOctober 14, 2024
✔ NPI 1063555944 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in MI · 5101013856
Definition
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.
1234 NAPIER AVE, Saint Joseph, MI 49085
Open in Google Maps ↗

Secondary Practice Location 1

Location 1601 John St, Box 74Kalamazoo, MI 49007-5341 · Phone (269) 341-8481 · Fax (269) 341-7781

Other Identifiers 2

Other0C97618MI · Bcbsm
Medicaid1063555944MI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, Priority Health.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

Penny Rathburn Do 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 ID2062447808
PECOS Enrollment IDI20050930000150
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.
189 services98 patients
Hospital discharge day management, 30 minutes or less 99238
Hospital discharge day management of 30 minutes or less includes finalizing your treatment, discussing your progress, and planning after-care at home. It ensures you're ready to leave the hospital and continue recovery safely.
85 services85 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.
68 services43 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.
41 services41 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
29 services29 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.
24 services24 patients

Hospital Affiliations CMS Care Compare

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

Lakeland Hospital, St Joseph

Acute Care Hospitals · St Joseph, MI
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number230021
Location1234 Napier AvenueSt Joseph, MI 49085 · Berrien County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 49085 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
$126.15 typical visit price
range $54.34 – $166.68
Typical copayment $31.53 (range $13.58 – $41.67)
Most-billed visit code 99204
Established Patient
$96.44 typical visit price
range $17.09 – $135.40
Typical copayment $24.11 (range $4.27 – $33.85)
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.

84.88/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality81.29
Promoting Interoperability100
Improvement Activities40
Cost68.32

Referred Medical Equipment & Supplies CMS DME claims 2

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

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390
DME-Oxygen and Supplies · category DC002N
2 suppliers24 claims24 services$83.31 avg. paid by Medicare
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing K0738
DME-Oxygen and Supplies · category DC000N
1 supplier14 claims14 services$30.84 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.

HANY S MESIHA MD
Internal Medicine
1234 NAPIER AVE
SAINT JOSEPH, MI 49085
Berrien County (269) 983-8300
CORY MINIER SCHMIDT MD
Pediatrics
1234 NAPIER AVE
SAINT JOSEPH, MI 49085
Berrien County (269) 985-4632
JORDAN ANDERSON
Occupational Therapist
1234 NAPIER AVE
SAINT JOSEPH, MI 49085
Berrien County (269) 983-8332
DR. KAREN J DYER M.D.
Pediatrics
1234 NAPIER AVE
SAINT JOSEPH, MI 49085
Berrien County (269) 985-4632
MR. NATHAN JOHN JORDAN MD
Radiology (Diagnostic Radiology)
1234 NAPIER AVE
ST JOSEPH, MI 49085
Berrien County (269) 983-8300
DR. JAMES G. SISAMIS MD
Anesthesiology
1234 NAPIER AVE
SAINT JOSEPH, MI 49085
Berrien County (269) 428-0118
DR. DIEGO P BETITA MD
Anesthesiology
1234 NAPIER AVE
SAINT JOSEPH, MI 49085
Berrien County (269) 428-0118
DR. JESSICA LYNN HAMILL SCHINDLER D.O.
Emergency Medicine
1234 NAPIER AVE, LAKELAND REGIONAL MEDICAL CENTER
SAINT JOSEPH, MI 49085
Berrien County (269) 982-4941

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 Penny Rathburn's NPI number?

The NPI number for Penny Rathburn is 1063555944. It was assigned to this individual provider in the NPPES registry on February 14, 2007.

Where is Penny Rathburn located?

Penny Rathburn practices at 1234 Napier Ave, Saint Joseph, MI 49085. The listed phone number is (269) 985-4632.

What is Penny Rathburn's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Penny Rathburn enrolled in Medicare?

Yes. Penny Rathburn 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 Penny Rathburn accept?

Health plans from Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company and Priority Health list Penny Rathburn 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 Penny Rathburn affiliated with any hospitals?

According to CMS data, Penny Rathburn is affiliated with Lakeland Hospital, St Joseph.

When was this NPI record last updated?

The NPPES record for Penny Rathburn was last updated on October 14, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months 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.