Individual provider Active NPI

Saravanakumar Manickam, MD

  • Anesthesiology Physician
  • Normal, IL
National Provider Identifier
1013316769
Registry record updated Feb 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
036172305 Issued in IL
Practice address
1304 Franklin Ave
Normal, IL 61761-3558
Phone
(309) 268-5867
NPI assigned
Aug 19, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 036172305 IL Primary
Anesthesiology Physician 207L00000X 296525 NY

Addresses

Primary practice location

1304 Franklin Ave
Normal, IL 61761-3558

Mailing address

611 W Park St
Urbana, IL 61801-2501

Other practice location 1

1 Guthrie Dr
Corning, NY 14830-3696
Phone (607) 937-7200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address msaravankumar146207@direct-guthrie.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, IL2 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

Enrollment IDStateProvider typePAC IDDetails
I20191119002683 NY Practitioner - Anesthesiology 9931329802 Reassigns benefits to 1 organization
I20241209000268 IL Practitioner - Anesthesiology 9931329802 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle West Physician Group IncGroup PAC ID 8921420308, 282 clinicians
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

2204 Eastland Dr
Bloomington, IL 61704-3567
Phone (309) 663-0222

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

Hospital & facility affiliations

  • Carle Bromenn Medical Center Hospital, Normal, IL, CCN 140127
  • St Joseph Medical Center Hospital, Bloomington, IL, CCN 140162

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036172305ILMDAnesthesiology Physician
296525NYMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Care Incorporated Anesthesiology CurrentSince Oct 4, 2025 Accepting new patients
Guthrie Medical Group, P.C. CurrentSince Sep 15, 2019 Accepting new patients
Guthrie Medical Group, P.C. Anesthesiology CurrentSince Sep 15, 2019 Accepting new patients
Carle West Physician Group Inc CurrentSince Nov 18, 2024 Accepting new patients

Locations

2204 Eastland Dr
Bloomington, IL 61704
Phone (309) 662-9461

1304 Franklin Ave
Normal, IL 61761
Phone (309) 268-3590

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

130 Center Way
Corning, NY 14830
Phone (607) 936-9971

1 Guthrie Dr
Corning, NY 14830
Phone (607) 937-7130

1 Guthrie Sq
Sayre, PA 18840
Phone (570) 887-3106

Interoperability endpoints

  • Direct secure messaging: smanickammd433722@carlehiedirect.net

Organizations & group practices 4

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1408406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739750400000",
    "number": "1013316769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 FRANKLIN AVE",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617613558",
            "telephone_number": "309-268-5867"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Guthrie Dr",
            "address_purpose": "LOCATION",
            "city": "Corning",
            "state": "NY",
            "postal_code": "148303696",
            "country_code": "US",
            "telephone_number": "607-937-7200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANICKAM",
        "first_name": "SARAVANAKUMAR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-19",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036172305",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "296525",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msaravankumar146207@direct-guthrie.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1 Guthrie Dr",
            "city": "Corning",
            "state": "NY",
            "country_code": "US",
            "postal_code": "148303696",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Normal, IL

Sources for this page

Verify at the official NPI Registry.