NPIMap

Individual provider Active NPI

Sanjay Pethkar, M.D.

  • Internal Medicine Physician
  • Plainfield, IL
National Provider Identifier
1134181829
Registry record updated Nov 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036091255 Issued in IL
Practice address
13415 S Route 59
Plainfield, IL 60585-5676
Phone
(815) 609-3627
Fax
(815) 609-1328
NPI assigned
Apr 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036091255 IL Primary

Addresses

Primary practice location

13415 S Route 59
Plainfield, IL 60585-5676

Mailing address

PO Box 9200
Naperville, IL 60567-0200
Phone (815) 609-3627

Other identifiers 1

IdentifierTypeStateIssuer
036091255MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20070911000401 IL Practitioner - Internal Medicine 8123111853 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sanjay Pethkar, M.D., S. C.Group PAC ID 9830282565, 5 clinicians

Practice addresses (Care Compare)

13415 S Route 59
Plainfield, IL 60585-5676

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036091255ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sanjay Pethkar, M.D., S. C. Internal Medicine CurrentSince Apr 21, 2003 Accepting new patients
Health Service Systems, Inc Internal Medicine Past Accepting new patients
Anjali Kher, M.D., S.C. Past Accepting new patients

Locations

1421 Essington Rd
Joliet, IL 60435
Phone (815) 729-3627

2776 Forgue Dr
Naperville, IL 60564

13415 S Route 59
Plainfield, IL 60585
Phone (815) 274-6688

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CIJFCD/Endpoint/CIJFCD

Organizations & group practices 3

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 7

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": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321315200000",
    "number": "1134181829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9200",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605670200",
            "telephone_number": "815-609-3627",
            "fax_number": "815-609-1328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13415 S ROUTE 59",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605855676",
            "telephone_number": "815-609-3627",
            "fax_number": "815-609-1328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETHKAR",
        "first_name": "SANJAY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2011-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036091255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036091255",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainfield, IL

Sources for this page

Verify at the official NPI Registry.