NPIMap

Individual provider Active NPI

Sanjay A Patwardhan, M.D.

  • Internal Medicine Physician
  • Chesterfield, MO
National Provider Identifier
1073583803
Registry record updated Dec 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
107804 Issued in MO
Practice address
14314 Manderleigh Woods Dr
Chesterfield, MO 63017-8055
Phone
(636) 566-8155
Fax
(314) 576-0809
NPI assigned
Jan 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 107804 MO Primary
Hospitalist Physician 208M00000X 107804 MO

Addresses

Primary practice location

14314 Manderleigh Woods Dr
Chesterfield, MO 63017-8055

Mailing address

PO Box 958946
Saint Louis, MO 63195-8946

Other identifiers 2

IdentifierTypeStateIssuer
1073583803MedicaidMO
1073583803MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040626000339 MO Practitioner - Internal Medicine 1153307582 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Medicine Group LLCGroup PAC ID 4385803931, 2 clinicians

Practice addresses (Care Compare)

10010 Kennerly Rd
Saint Louis, MO 63128-2106
Phone (314) 525-1328

1015 Bowles Ave
Fenton, MO 63026-2394
Phone (636) 496-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
107804MOMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Anthonys Physician Organization Hospitalist Services, L.C. Hospitalist CurrentSince Jun 1, 2022 Accepting new patients
Physician Specialists of St Lukes LLC Internal Medicine CurrentSince Jul 25, 2017 Accepting new patients
Sound Physicians of Illinois, LLC Internal Medicine CurrentSince Aug 29, 2017 Accepting new patients
Midwest Medicine Group, LLC Internal Medicine CurrentSince Jan 1, 2014 Accepting new patients
Inpatient Consultants of Missouri Inc Internal Medicine Past Accepting new patients
Gavini Medical Group,LTD Past Accepting new patients
Garden View Care Center of Chesterfield, Inc. Past Accepting new patients
Sanjay a. Patwardhan, MD, PC Internal Medicine PastSince May 1, 2004 Accepting new patients
Mount Carmel Communities, LLC Past Accepting new patients

Locations

12303 De Paul Dr
Bridgeton, MO 63044
Phone (314) 344-6360

121 Saint Lukes Center Dr
Chesterfield, MO 63017
Phone (314) 434-3278

167 Lamp and Lantern Vlg
Chesterfield, MO 63017
Phone (314) 729-1717

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

100 Medical Plz
Lake St Louis, MO 63367
Phone (636) 625-5200

300 1st Capitol Dr
Saint Charles, MO 63301
Phone (636) 669-2211

6420 Clayton Rd
Saint Louis, MO 63117
Phone (314) 768-8442

10010 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 525-1328

615 S New Ballas Rd
#C
Saint Louis, MO 63141
Phone (314) 569-6000

232 S Woods Mill Rd
Town and Country, MO 63017
Phone (314) 205-6030

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Garden View Care Center at Dougherty FerryValley Park, MO, CCN 265808 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Apr 1, 2023
Apr 1, 2023
Garden View Care CenterO Fallon, MO, CCN 265321 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Apr 1, 2023
Apr 1, 2023

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

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 8

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": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386288000000",
    "number": "1073583803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 958946",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631958946",
            "fax_number": "314-576-0809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14314 MANDERLEIGH WOODS DR",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630178055",
            "telephone_number": "636-566-8155",
            "fax_number": "314-576-0809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATWARDHAN",
        "first_name": "SANJAY",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2013-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "107804",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MO",
            "license": "107804",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073583803",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073583803",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

Verify at the official NPI Registry.