Individual provider Active NPI

Sanjay S. Jain, MD

  • Pulmonary Disease Physician
  • Fort Wayne, IN
National Provider Identifier
1205803632
Registry record updated Sep 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
01060078A Issued in IN
Practice address
7916 W Jefferson Blvd
Fort Wayne, IN 46804-4140
Phone
(260) 432-2297
Fax
(260) 434-6481
NPI assigned
Mar 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Internal Medicine) Physician 207RS0012X 01060078A IN
Pulmonary Disease Physician 207RP1001X 01060078A IN Primary

Addresses

Primary practice location

7916 W Jefferson Blvd
Fort Wayne, IN 46804-4140

Mailing address

6920 Pointe Inverness Way Ste 200
Medpartners, Attn: Barb Copeland
Fort Wayne, IN 46804-7934
Phone (260) 479-3514

Other identifiers 4

IdentifierTypeStateIssuer
000000354843OtherINANTHEM
P00191330OtherRAILROAD
2538016MedicaidOH
200506290MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sanjay.jain@lutheranhealthnetwork.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, OH2 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
I20050301000307 IN Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists)Practitioner - Sleep Medicine 6204727548 Reassigns benefits to 1 organization
I20071005000466 OH Practitioner - Pulmonary Disease 6204727548 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary Disease
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lutheran Medical Group LLCGroup PAC ID 4981751617, 251 clinicians

Practice addresses (Care Compare)

1035 W Wayne St
Paulding, OH 45879-1544
Phone (419) 399-4080

2510 E Dupont Rd
Suite 206
Fort Wayne, IN 46825-1602
Phone (260) 416-5954

7916 W Jefferson Blvd
Fort Wayne, IN 46804-4140

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.99 of 100Reported as apm
Quality
77.41
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as group
Quality
0
Improvement activities
0
Cost
0

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01060078AINMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lutheran Medical Group LLC CurrentSince May 1, 2009 Accepting new patients
Lutheran Medical Group LLC Pulmonary Disease CurrentSince May 1, 2009 Accepting new patients
Curators of the University of Missouri Past Accepting new patients

Locations

516 E Maumee St
Ste C
Angola, IN 46703

955 High St
Ste 3
Decatur, IN 46733
Phone (219) 724-2125

6920 Pointe Inverness Way
Ste 200
Fort Wayne, IN 46804
Phone (260) 479-3514

2510 E DuPont Rd
Ste 206
Fort Wayne, IN 46825
Phone (260) 416-5954

3534 Brooklyn Ave
Fort Wayne, IN 46809
Phone (219) 478-5180

7916 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 432-2298

2516 E DuPont Rd
Fort Wayne, IN 46825
Phone (260) 434-6076

1035 W Wayne St
Paulding, OH 45879
Phone (419) 399-4080

1250 S Washington St
Van Wert, OH 45891
Phone (419) 232-2077

Interoperability endpoints

  • Direct secure messaging: sanjay.jain@lutheranhealthnetwork.cernerdirect.com

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 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": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601337600000",
    "number": "1205803632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6920 POINTE INVERNESS WAY STE 200",
            "address_2": "MEDPARTNERS, ATTN: BARB COPELAND",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468047934",
            "telephone_number": "260-479-3514",
            "fax_number": "260-479-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7916 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044140",
            "telephone_number": "260-432-2297",
            "fax_number": "260-434-6481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAIN",
        "first_name": "SANJAY",
        "middle_name": "S.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-03",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "IN",
            "license": "01060078A",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IN",
            "license": "01060078A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000354843",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00191330",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2538016",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200506290",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sanjay.jain@lutheranhealthnetwork.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "7916 W Jefferson Blvd",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468044140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.