DR. RAJENDRA S RATHOUR MD
NPI 1235128844
Internal Medicine in Milwaukee, WI

Active since October 17, 2005PECOS EnrolledAccepts Medicare Assignment
82.39/100
CMS Quality Rating
3201 S 16TH ST, ROOM 1000, MILWAUKEE, WI 53215(414) 389-3180(414) 645-8240 Get Directions Write a Review

NPPES record last updated: June 14, 2012. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Dr. Rajendra S Rathour Md NPPES

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

DR. RAJENDRA S RATHOUR MD (NPI 1235128844) is an individual internal medicine provider in Milwaukee, Wisconsin, licensed in Wisconsin (33194) and active in the NPI registry since October 2005. He is enrolled in Medicare PECOS, is affiliated with Ascension St Francis Hospital, and is a graduate of Other (1978).

NPPES Registry Identity

NPI1235128844
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameDR. RAJENDRA S RATHOURCredential: MD
Location Address3201 S 16TH ST, ROOM 1000Milwaukee, WI 53215-4537
Mailing Address3201 S 16th St, Room 1000Milwaukee, WI 53215-4537 · (414) 389-3180 · Fax (414) 645-8240
Fax(414) 645-8240
Sole ProprietorNo
Medical School CMSOtherGraduated 1978
Enumeration DateOctober 17, 2005
Last NPPES UpdateJune 14, 2012
NPI 1235128844 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License Licensed in WI · 33194
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.

3201 S 16TH ST, Milwaukee, WI 53215

Other Identifiers 3

Medicare ID-Type Unspecified732000009WI
Medicare UPINF34501WI
Medicaid31847900WI

Accepted 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

Dr. Rajendra S Rathour 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 ID1355422700
PECOS Enrollment IDI20080111000365
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 2024 & 2026 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, 30-39 minutes 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.
144 services53 patients
Follow-up nursing facility visit per day, typically 15 minutes 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.
108 services28 patients
Established patient office or other outpatient visit, 20-29 minutes 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
71 services36 patients
Follow-up hospital inpatient care per day, typically 25 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.
64 services24 patients
Follow-up nursing facility visit per day, typically 25 minutes 99309
A follow-up nursing facility visit per day is a daily check-in by a healthcare professional. This 25-minute visit typically involves monitoring your health progress, addressing any concerns, and adjusting treatment plans as necessary. It's a vital part of ensuring your ongoing wellbeing.
46 services17 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
24 services24 patients

Hospital Affiliations CMS Care Compare

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

Ascension St Francis Hospital

Acute Care Hospitals · Milwaukee, WI
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number520078
Location3237 S 16th StMilwaukee, WI 53215 · Milwaukee County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53215 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
$123.69 typical visit price
range $53.90 – $163.24
Typical copayment $30.92 (range $13.47 – $40.81)
Most-billed visit code 99204
Established Patient
$95.41 typical visit price
range $17.40 – $133.76
Typical copayment $23.85 (range $4.35 – $33.44)
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.

82.39/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality77.88
Promoting Interoperability81
Improvement Activities40
Cost74.38

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.

Urology
3201 S 16TH ST, STE 1015
MILWAUKEE, WI 53215
Internal Medicine
3201 S 16TH ST, ROOM 1000
MILWAUKEE, WI 53215
Internal Medicine
3201 S 16TH ST, ROOM 1000
MILWAUKEE, WI 53215
Internal Medicine
3201 S 16TH ST, ROOM 1000
MILWAUKEE, WI 53215
Internal Medicine
3201 S 16TH ST, RM 1000
MILWAUKEE, WI 53215
Internal Medicine (Gastroenterology)
3201 S 16TH ST, 2015
MILWAUKEE, WI 53215
Internal Medicine (Gastroenterology)
3201 S 16TH ST, 2015
MILWAUKEE, WI 53215
Neurological Surgery
3201 S 16TH ST, STE 1005
MILWAUKEE, WI 53215

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1235128844, enumerated as an "individual" on October 17, 2005.

The provider is located at 3201 S 16TH ST ROOM 1000 MILWAUKEE, WI 53215 and the phone number is (414) 389-3180.

Internal Medicine with taxonomy code 207R00000X.

The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield, Network Health,. Please consult your insurance carrier or call the provider to verify.

Rajendra Rathour is affiliated with: ASCENSION ST FRANCIS HOSPITAL.