Active NPI
Sanjay Saxena, M.D.
- Pediatrics Physician
- Bloomington, IL
National Provider Identifier
1174625867
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036098372
- Practice address
- 2427 Maloney Dr
Bloomington, IL 61704-3750 - Phone
- (309) 663-1011
- Fax
- (309) 665-0825
- NPI assigned
- Sep 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036098372 | IL | Primary |
Addresses
Primary practice location
2427 Maloney Dr
Bloomington, IL 61704-3750
Mailing address
2811 Hubbard Dr
Bloomington, IL 61704-9096
Phone (309) 664-2515
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036098372 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036098372 | IL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Illinois Pediatric Associates LLC | Past | Accepting new patients | |
| Gibson Community Hospital Association | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/FHCFCA/Endpoint/FHCFCA
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.
-
- Primary Care Clinic/Center
- Bloomington, IL
- NPI 1174706816
-
- Critical Access Hospital
- Gibson City, IL
- NPI 1114935681
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694304000000",
"number": "1174625867",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2811 HUBBARD DR",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617049096",
"telephone_number": "309-664-2515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2427 MALONEY DR",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617043750",
"telephone_number": "309-663-1011",
"fax_number": "309-665-0825"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAXENA",
"first_name": "SANJAY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-02",
"last_updated": "2023-09-10",
"certification_date": "2023-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036098372",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036098372",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.