Individual provider Active NPI

Pankaj A Patel, M.D.

  • Gastroenterology Physician
  • South Bend, IN
National Provider Identifier
1124022082
Registry record updated Jan 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
01049700A Issued in IN
Practice address
17501 Generations Dr
South Bend, IN 46635-1589
Phone
(574) 234-0049
Fax
(574) 251-2861
NPI assigned
Jun 9, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 01049700A IN Primary

Addresses

Primary practice location

17501 Generations Dr
South Bend, IN 46635-1589

Mailing address

17501 Generations Dr
South Bend, IN 46635-1589
Phone (574) 234-0049

Other identifiers 5

IdentifierTypeStateIssuer
7580376OtherINAETNA
000000225361OtherINBCBS
0649925002OtherINCIGNA
200377140AMedicaidIN
100016227OtherINRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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 1

Enrollment IDStateProvider typePAC IDDetails
I20101101000938 IN Practitioner - Internal MedicinePractitioner - Gastroenterology 5496852139 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Gastroenterology
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Michiana Gastroenterology, IncGroup PAC ID 2163529892, 12 clinicians

Practice addresses (Care Compare)

17501 Generations Dr
South Bend, IN 46635-1589
Phone (574) 234-0049

Hospital & facility affiliations

  • Saint Joseph Regional Medical Center Hospital, Mishawaka, IN, CCN 150012
  • Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058

Merit-based Incentive Payment System (MIPS)

Final score
54.01 of 100Reported as individual
Quality
0
Improvement activities
40
Cost
80.03

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy156
Upper gastrointestinal (GI) endoscopy for acid reflux249

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01049700AINMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Michiana Gastroenterology, Inc Gastroenterology CurrentSince Jul 1, 2002 Accepting new patients
MG Anesthesia, LLC Past Accepting new patients

Locations

900 I St
Laporte, IN 46350
Phone (219) 324-1670

1919 Lake Ave
Plymouth, IN 46563
Phone (219) 236-1888

17501 Generations Dr
South Bend, IN 46635
Phone (574) 234-0049

53830 Generations Dr
South Bend, IN 46635
Phone (574) 217-0174

211 N Eddy St
South Bend, IN 46617
Phone (574) 237-9331

Interoperability endpoints

  • Direct secure messaging: ppatel1158731@direct.trinity-health.org

Organizations & group practices 2

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 5

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": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295568000000",
    "number": "1124022082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17501 GENERATIONS DR",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351589",
            "telephone_number": "574-234-0049",
            "fax_number": "574-251-2861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17501 GENERATIONS DR",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351589",
            "telephone_number": "574-234-0049",
            "fax_number": "574-251-2861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "PANKAJ",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2011-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IN",
            "license": "01049700A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7580376",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000225361",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0649925002",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200377140A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "100016227",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.