Kharisa Nur Rachmasari, M.D.

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

82656 Issued in WI

Practice address

700 West Avenue S
La Crosse, WI 54601-8806

Phone

(608) 785-0940

NPI assigned

Apr 16, 2018

Reactivated

Dec 19, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN, WI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Endocrinology

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mayo Clinic Health System-Southwest Wisconsin Region IncGroup PAC ID 0345152443, 539 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mayo Clinic Health System-Franciscan Medical Center Inc Hospital, La Crosse, WI, CCN 520004
• Mayo Clinic Health System Eau Claire Hospital Hospital, Eau Claire, WI, CCN 520070
• Mayo Clinic Health System-Northland Hospital, Barron, WI, CCN 521315
• Mayo Clinic HLTH Systm Franciscan Hlthcare Sparta Hospital, Sparta, WI, CCN 521305
• Mayo Clinic Health System Chippewa Valley Hospital, Bloomer, WI, CCN 521314

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mayo Clinic Health System-Southwest Wisconsin Region, Inc.

  • Multi-Specialty Clinic/Center
  • La Crosse, WI
  • NPI 1629056049
  Medicare reassignment Care Compare group NPD
• Mayo Clinic

  • Multi-Specialty Clinic/Center
  • Rochester, MN
  • NPI 1922074434
  Medicare reassignment NPD
• Mayo Clinic Health System-Southwest Wisconsin Region, Inc.

  • Multi-Specialty Clinic/Center
  • La Crosse, WI
  • NPI 1942980917
  NPD
• Mayo Clinic

  • Clinical Medical Laboratory
  • Rochester, MN
  • NPI 1083249577
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  • General Acute Care Hospital
  • Eau Claire, WI
  • NPI 1629027578
  Care Compare affiliation
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  • Critical Access Hospital
  • Bloomer, WI
  • NPI 1700837812
  Care Compare affiliation
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  • Critical Access Hospital
  • Barron, WI
  • NPI 1740239557
  Care Compare affiliation
• Mayo Clinic Health System-Southwest Wisconsin Region, Inc.

  • General Acute Care Hospital
  • La Crosse, WI
  • NPI 1801874227
  Care Compare affiliation
• Mayo Clinic Health System-Southwest Wisconsin Region, Inc.

  • Critical Access Hospital
  • Sparta, WI
  • NPI 1841278637
  Care Compare affiliation
• Mayo Clinic Health System-Southwest Wisconsin Region, Inc.

  • Rural Health Clinic/Center
  • Arcadia, WI
  • NPI 1972091361

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1225525215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "507-284-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 WEST AVENUE S",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546018806",
            "telephone_number": "608-785-0940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 1st St SW",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "559050001",
            "country_code": "US",
            "telephone_number": "507-284-2511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RACHMASARI",
        "first_name": "KHARISA",
        "middle_name": "NUR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-16",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "deactivation_date": "2018-11-28",
        "reactivation_date": "2018-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MN",
            "license": "69190",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "WI",
            "license": "82656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krachmasari1425394@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "700 West Avenue S",
            "city": "La Crosse",
            "state": "WI",
            "country_code": "US",
            "postal_code": "546018806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michael R Quinn, DPM
• Hannah Elizabeth Raabe, MD
• Jessica Rabbitt
• Chelsea Marie Rabe
• Laurie Marie Rabl-Diemert, MSW APSW
• Rebecca Leann Radcliffe, BSW
• Rebecca Lynn Rademacher, MSN
• Diane K Radisewitz Rommes, PHD
• Emily Diana Rae, MD
• Amber M Rahm, PA

• Endocrinology, Diabetes & Metabolism Physician in La Crosse, WI
• Providers in La Crosse, WI by specialty
• Endocrinology, Diabetes & Metabolism Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.