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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: August 09, 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
Phone(414) 389-3180
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
Open in Google Maps ↗

Other Identifiers 3

Medicare ID-Type Unspecified732000009WI
Medicare UPINF34501WI
Medicaid31847900WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Network 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

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 7

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.
162 services64 patients
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 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.
33 services11 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.
26 services21 patients
Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
24 services24 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 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.
22 services18 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.
22 services22 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.

NEUROLOGY CENTER OF MILWAUKEE, LLC
Psychiatry & Neurology (Neurology)
3201 S 16TH ST, SUITE 1019
MILWAUKEE, WI 53215
Milwaukee County (414) 342-6300
JITENDRA K BARUAH MD SC
Psychiatry & Neurology (Neurology)
3201 S 16TH ST, SUITE 200
MILWAUKEE, WI 53215
Milwaukee County (414) 384-5581
RAKESH WAGHRAY MD
Internal Medicine (Pulmonary Disease)
3201 S 16TH ST, 2015
MILWAUKEE, WI 53215
Milwaukee County (414) 649-3810
MRS. ALLISON MARGARET JUECH PA
Physician Assistant
3201 S 16TH ST, SUITE 100
MILWAUKEE, WI 53215
Milwaukee County (414) 647-5203
ST. FRANCIS GRAPHICS
Internal Medicine (Cardiovascular Disease)
3201 S 16TH ST
MILWAUKEE, WI 53215
Milwaukee County (414) 438-2450
W. I. FRANKOWSKI, MD, SC
Family Medicine
3201 S 16TH ST, SUITE 1010
MILWAUKEE, WI 53215
Milwaukee County (414) 643-0711
PHYSIATRISTS ASSOCIATES, LTD
Physical Medicine & Rehabilitation
3201 S 16TH ST, 800
MILWAUKEE, WI 53215
Milwaukee County (414) 647-9985
DR. VELUVOLU K RAO MD
Internal Medicine
3201 S 16TH ST, ROOM 1000
MILWAUKEE, WI 53215
Milwaukee County (414) 389-3180

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 Rajendra Rathour's NPI number?

The NPI number for Rajendra Rathour is 1235128844. It was assigned to this individual provider in the NPPES registry on October 17, 2005.

Where is Rajendra Rathour located?

Rajendra Rathour practices at 3201 S 16th St Room 1000, Milwaukee, WI 53215. The listed phone number is (414) 389-3180.

What is Rajendra Rathour's specialty?

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

Is Rajendra Rathour enrolled in Medicare?

Yes. Rajendra Rathour 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 Rajendra Rathour accept?

Health plans from Anthem Blue Cross and Blue Shield and Network Health list Rajendra Rathour 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 Rajendra Rathour affiliated with any hospitals?

According to CMS data, Rajendra Rathour is affiliated with Ascension St Francis Hospital.

When was this NPI record last updated?

The NPPES record for Rajendra Rathour was last updated on June 14, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.