DR. NIHAL HERATH MD
NPI 1972578466
Psychiatry & Neurology - Neurology in Grafton, WI

Q: What is Nihal Herath's NPI number?

The NPI number for Nihal Herath is 1972578466. It was assigned to this individual provider in the NPPES registry on February 20, 2006.

Q: What is Nihal Herath's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Neurology, with taxonomy code 2084N0400X.

Q: When was this NPI record last updated?

The NPPES record for Nihal Herath was last updated on April 23, 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.

Active since February 20, 2006PECOS EnrolledAccepts Medicare Assignment

975 PORT WASHINGTON RD, GRAFTON, WI 53024(262) 329-1000 Get Directions Write a Review

NPPES record last updated: April 23, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 23, 2024, Nov 23, 2021, Mar 10, 2021 and 1 more (4 updates tracked since 2018).

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About Dr. Nihal Herath Md NPPES

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

DR. NIHAL HERATH MD (NPI 1972578466) is an individual neurology provider in Grafton, Wisconsin, licensed in Wisconsin (40848) and active in the NPI registry since February 2006. He is enrolled in Medicare PECOS, is affiliated with Aurora St Lukes Medical Center, and is a graduate of Other (1982).

NPPES Registry Identity

NPI1972578466

Entity TypeIndividualMale

Primary Taxonomy2084N0400X

Provider Legal NameDR. NIHAL HERATHCredential: MD

Location Address975 PORT WASHINGTON RDGrafton, WI 53024-9201

Mailing AddressPo Box 735044Chicago, IL 60673-5044 · (800) 326-2250

Phone(262) 329-1000

Sole ProprietorNo

Medical School CMSOtherGraduated 1982

Enumeration DateFebruary 20, 2006

Last NPPES UpdateApril 23, 20244 updates tracked since enumeration

NPPES CertifiedApril 23, 2024

✔ NPI 1972578466 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychiatry & Neurology · NeurologyAllopathic & Osteopathic Physicians

Taxonomy Code2084N0400X

License✔ Licensed in WI · 40848

Definition

A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.

Also ListedSpecialistTaxonomy 174400000X · License 40848 (WI)

975 PORT WASHINGTON RD, Grafton, WI 53024

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Other Identifiers 1

Medicaid34616000WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource (Common Ground Healthcare).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. Nihal Herath 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 ID648224899

PECOS Enrollment IDI20050310000108

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 3

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 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.

110 services72 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.

106 services102 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.

16 services16 patients

Hospital Affiliations CMS Care Compare 2

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

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 53024 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.

Referred Medical Equipment & Supplies CMS DME claims 8

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

Tubing with integrated heating element for use with positive airway pressure device A4604

DME-Other DME · category DE001N

5 suppliers39 claims39 services$36.33 avg. paid by Medicare

Full face mask used with positive airway pressure device, each A7030

DME-Other DME · category DE001N

5 suppliers30 claims30 services$76.57 avg. paid by Medicare

Face mask interface, replacement for full face mask, each A7031

DME-Other DME · category DE001N

4 suppliers27 claims80 services$29.32 avg. paid by Medicare

Cushion for use on nasal mask interface, replacement only, each A7032

DME-Other DME · category DE001N

3 suppliers16 claims96 services$17.78 avg. paid by Medicare

Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034

DME-Other DME · category DE001N

3 suppliers21 claims21 services$50.26 avg. paid by Medicare

Headgear used with positive airway pressure device A7035

DME-Other DME · category DE001N

4 suppliers28 claims28 services$15.57 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.

ANNE R. HARLEY P.T.

Physical Therapist