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DR. NIRAJ SAWHNEY M.D, MRCP
NPI 1255435285
Internal Medicine - Infectious Disease in Milwaukee, WI

Active since September 11, 2006PECOS EnrolledAccepts Medicare Assignment
79.61/100
CMS Quality Rating
2025 W OKLAHOMA AVE, SUITE 114, MILWAUKEE, WI 53215(414) 647-1537(414) 647-1560 Get Directions Write a Review

NPPES record last updated: August 25, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Dr. Niraj Sawhney M.d, Mrcp NPPES

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

DR. NIRAJ SAWHNEY M.D, MRCP (NPI 1255435285) is an individual infectious disease provider in Milwaukee, Wisconsin, licensed in Wisconsin (36718) and active in the NPI registry since September 2006. He is enrolled in Medicare PECOS, is affiliated with Froedtert South Inc., and maintains a secondary practice location in Grafton.

NPPES Registry Identity

NPI1255435285
Entity TypeIndividualMale
Primary Taxonomy207RI0200X
Provider Legal NameDR. NIRAJ SAWHNEYCredential: M.D, MRCP
Location Address2025 W OKLAHOMA AVE, SUITE 114Milwaukee, WI 53215-4455
Mailing Address2025 W Oklahoma Ave Ste 114Milwaukee, WI 53215-4455 · (414) 647-1537 · Fax (414) 647-1560
Phone(414) 647-1537
Fax(414) 647-1560
Sole ProprietorNo
Medical School CMSOtherGraduated 1978
Enumeration DateSeptember 11, 2006
Last NPPES UpdateAugust 25, 2026
NPPES CertifiedAugust 25, 2026
✔ NPI 1255435285 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Infectious DiseaseAllopathic & Osteopathic Physicians
Taxonomy Code207RI0200X
License✔ Licensed in WI · 36718
Definition
An internist who deals with infectious diseases of all types and in all organ systems. Conditions requiring selective use of antibiotics call for this special skill. This physician often diagnoses and treats AIDS patients and patients with fevers which have not been explained. Infectious disease specialists may also have expertise in preventive medicine and travel medicine.
2025 W OKLAHOMA AVE, Milwaukee, WI 53215
Open in Google Maps ↗

Secondary Practice Location 1

Location 1975 Port Washington RdGrafton, WI 53024-9201 · Phone (262) 329-1000

Other Identifiers 1

Medicaid32129600WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Aspirus Health Plan, CareSource (Common Ground Healthcare) and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Niraj Sawhney M.d, Mrcp 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 ID3971576620
PECOS Enrollment IDI20100913000807
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.

Medicare Billing Reassignments

2

Medicare enrollment records show Niraj Sawhney reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Aurora Advanced Healthcare, Inc.
11 mi
Family Medicine
3003 W GOOD HOPE RD
Milwaukee, WI 53209
  • Reassigned Medicare billing, Wisconsin enrollment
  • 1,615 clinicians in this Medicare group
NPI 1265629133 (414) 352-3100
Froedtert South, Inc.
29 mi
Family Medicine
6308 8TH AVE
Kenosha, WI 53143
  • Reassigned Medicare billing, Wisconsin enrollment
  • 212 clinicians in this Medicare group
NPI 1558305284 (262) 656-2718

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 5

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.
368 services110 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.
138 services116 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.
126 services55 patients
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.
42 services29 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.
14 services11 patients

Hospital Affiliations CMS Care Compare 3

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

Froedtert South Inc.

Acute Care Hospitals · Pleasant Prairie, WI
1/5 CMS rating
OwnershipGovernment - Local
CMS Certification Number520021
Location9555 76th StPleasant Prairie, WI 53158 · Kenosha County
Emergency services

Aurora St Lukes Medical Center

Acute Care Hospitals · Milwaukee, WI
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number520138
Location2900 W Oklahoma AveMilwaukee, WI 53215 · Milwaukee County
Emergency services Birthing friendly

Aurora Medical Center

Acute Care Hospitals · Grafton, WI
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number520207
Location975 Port Washington RoadGrafton, WI 53024 · Ozaukee County
Emergency services Birthing friendly

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.

79.61/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality70.88
Promoting Interoperability100
Improvement Activities40
Cost61.15

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-NEURODIAGNOSTIC CENTER, S.C.
Psychiatry & Neurology (Neurology)
2025 W OKLAHOMA AVE, SUITE 120
MILWAUKEE, WI 53215
Milwaukee County (414) 382-8960
RAJ D PATEL M.D.
Internal Medicine (Cardiovascular Disease)
2025 W OKLAHOMA AVE
MILWAUKEE, WI 53215
Milwaukee County (414) 389-2797
MISS KRISTEN ELIZABETH BRODZELLER PT
Physical Therapist
2025 W OKLAHOMA AVE, SUITE 104
MILWAUKEE, WI 53215
Milwaukee County (414) 647-7678
WHEATON FRANCISCAN HEALTHCARE
Clinic/Center
2025 W OKLAHOMA AVE, SUITE 104
MILWAUKEE, WI 53215
Milwaukee County (414) 647-7678
MARSHAL J. MIRVISS M.D.
Internal Medicine
2025 W OKLAHOMA AVE
MILWAUKEE, WI 53215
Milwaukee County (414) 389-2790
DR. DANA L REAMY
Physical Therapist
2025 W OKLAHOMA AVE, SUITE 104
MILWAUKEE, WI 53215
Milwaukee County (414) 647-7678
RICHARD PAUL CHAMPEAU P.T.
Physical Therapist
2025 W OKLAHOMA AVE
MILWAUKEE, WI 53215
Milwaukee County (414) 647-7678
ST FRANCIS HOSPITAL
Rehabilitation Unit
2025 W OKLAHOMA AVE
MILWAUKEE, WI 53215
Milwaukee County (414) 647-7678

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 Niraj Sawhney's NPI number?

The NPI number for Niraj Sawhney is 1255435285. It was assigned to this individual provider in the NPPES registry on September 11, 2006.

Where is Niraj Sawhney located?

Niraj Sawhney practices at 2025 W Oklahoma Ave Suite 114, Milwaukee, WI 53215. The listed phone number is (414) 647-1537.

What is Niraj Sawhney's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Infectious Disease, with taxonomy code 207RI0200X.

Is Niraj Sawhney enrolled in Medicare?

Yes. Niraj Sawhney 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.

Which organizations bill Medicare for Niraj Sawhney's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Niraj Sawhney reassigns Medicare benefits to 2 organizations: Aurora Advanced Healthcare, Inc. (Milwaukee, WI) and Froedtert South, Inc. (Kenosha, WI). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Niraj Sawhney's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Niraj Sawhney accept?

Health plans from Anthem Blue Cross and Blue Shield, Aspirus Health Plan, CareSource (Common Ground Healthcare), HealthPartners and Network Health and 2 other insurers list Niraj Sawhney 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 Niraj Sawhney affiliated with any hospitals?

According to CMS data, Niraj Sawhney is affiliated with Froedtert South Inc., Aurora St Lukes Medical Center and Aurora Medical Center.

When was this NPI record last updated?

The NPPES record for Niraj Sawhney was last updated on August 25, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.