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DR. HERATH M WIJERATHNA M.D.
NPI 1912232307
Internal Medicine in Sutton, MA

Active since October 02, 2009PECOS Enrolled
188 WORCESTER PROVIDENCE TPKE, SUTTON, MA 01590(508) 865-3650(508) 865-3822 Get Directions Write a Review

NPPES record last updated: August 7, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Aug 7, 2024, Mar 19, 2018 (2 updates tracked since 2018).

About Dr. Herath M Wijerathna M.d. NPPES

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

DR. HERATH M WIJERATHNA M.D. (NPI 1912232307) is an individual internal medicine provider in Sutton, Massachusetts, licensed in Massachusetts (265447) and active in the NPI registry since October 2009. She is enrolled in Medicare PECOS, is affiliated with Umass Memorial Health - Harrington Hospital, and is a graduate of Other (1998).

NPPES Registry Identity

NPI1912232307
Entity TypeIndividualFemale
Primary Taxonomy207R00000X
Provider Legal NameDR. HERATH M WIJERATHNACredential: M.D.
Location Address188 WORCESTER PROVIDENCE TPKESutton, MA 01590-1908
Mailing AddressPo Box 415348Boston, MA 02241-5348 · (800) 225-8885 · Fax (508) 334-1977
Phone(508) 865-3650
Fax(508) 865-3822
Sole ProprietorNo
Medical School CMSOtherGraduated 1998
Enumeration DateOctober 2, 2009
Last NPPES UpdateAugust 7, 20242 updates tracked since enumeration
NPPES CertifiedAugust 7, 2024
✔ NPI 1912232307 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in MA · 265447
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.
188 WORCESTER PROVIDENCE TPKE, Sutton, MA 01590
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Other Names 1

Other Name (5)Dr. H.m. Nirmala Dayani Wijerathna M.d.

Accepted Insurance

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

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Herath M Wijerathna M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9032366620
PECOS Enrollment IDI20160725002628
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 Reassignment

Medicare enrollment records show Herath Wijerathna reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Umass Memorial Medical Group, Inc.
6.6 mi
Urgent Care
78 SUTTON AVE
Oxford, MA 01540
  • Reassigned Medicare billing, Massachusetts enrollment
  • 2,902 clinicians in this Medicare group
NPI 1982381018 (508) 499-1760

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 11

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.
82 services73 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.
40 services36 patients
Blood test, lipids (cholesterol and triglycerides) 80061
A lipid panel is a blood test that measures fats and fatty substances, such as cholesterol and triglycerides. These substances are used by your body as a source of energy. High levels can lead to health issues, including heart disease.
39 services38 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.
37 services37 patients
Blood test, comprehensive group of blood chemicals 80053
A comprehensive group of blood chemicals test, also known as a comprehensive metabolic panel, is a blood test that measures your sugar level, electrolyte and fluid balance, kidney function, and liver function. This helps to check your body's overall health.
34 services33 patients
Hemoglobin a1c level 83036
Hemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.
28 services26 patients

Hospital Affiliations CMS Care Compare 3

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

Umass Memorial Health - Harrington Hospital

Acute Care Hospitals · Southbridge, MA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220019
Location100 South StreetSouthbridge, MA 01550 · Worcester County
Emergency services

Milford Regional Medical Center

Acute Care Hospitals · Milford, MA
4/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number220090
Location14 Prospect StreetMilford, MA 01757 · Worcester County
Emergency services Birthing friendly

Umass Memorial Medical Center/University Campus

Acute Care Hospitals · Worcester, MA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220163
Location55 Lake Avenue NorthWorcester, MA 01655 · Worcester County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 01590 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
$134.47 typical visit price
range $58.86 – $177.36
Typical copayment $33.61 (range $14.71 – $44.34)
Most-billed visit code 99204
Established Patient
$103.48 typical visit price
range $19.11 – $144.84
Typical copayment $25.87 (range $4.77 – $36.21)
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.

Referred Medical Equipment & Supplies CMS DME claims 4

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

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
8 suppliers27 claims67 services$6.22 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
4 suppliers12 claims12 services$0.94 avg. paid by Medicare
Tubing with integrated heating element for use with positive airway pressure device A4604
DME-Other DME · category DE001N
3 suppliers11 claims11 services$35.96 avg. paid by Medicare
Filter, disposable, used with positive airway pressure device A7038
DME-Other DME · category DE001N
3 suppliers11 claims56 services$2.02 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 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. REBECCA KASENGE D.O.
Internal Medicine
188 WORCESTER PROVIDENCE TPKE
SUTTON, MA 01590
Worcester County (508) 865-3650
ABDULRAOUF G. GHANDOUR M.D.
Family Medicine
188 WORCESTER PROVIDENCE TPKE
SUTTON, MA 01590
Worcester County (508) 865-3650
DR. JAMES A GILBERT JR. M.D.
Internal Medicine
188 WORCESTER PROVIDENCE TPKE
SUTTON, MA 01590
Worcester County (508) 865-3650

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 Herath Wijerathna's NPI number?

The NPI number for Herath Wijerathna is 1912232307. It was assigned to this individual provider in the NPPES registry on October 2, 2009. The provider is also known as Dr. H.M. Nirmala Dayani Wijerathna M.D..

Where is Herath Wijerathna located?

Herath Wijerathna practices at 188 Worcester Providence Tpke, Sutton, MA 01590. The listed phone number is (508) 865-3650.

What is Herath Wijerathna's specialty?

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

Is Herath Wijerathna enrolled in Medicare?

Yes. Herath Wijerathna is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Herath Wijerathna's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Herath Wijerathna reassigns Medicare benefits to Umass Memorial Medical Group, Inc. (Oxford, MA). The 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 Herath Wijerathna's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Herath Wijerathna accept?

Health plans from Anthem Blue Cross and Blue Shield and Taro Health list Herath Wijerathna 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 Herath Wijerathna affiliated with any hospitals?

According to CMS data, Herath Wijerathna is affiliated with Umass Memorial Health - Harrington Hospital, Milford Regional Medical Center and Umass Memorial Medical Center/University Campus.

When was this NPI record last updated?

The NPPES record for Herath Wijerathna was last updated on August 7, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.