NPIMap

Individual provider Active NPI

Pankaj Jain, M.D.

  • Pulmonary Disease Physician
  • Olympia Fields, IL
National Provider Identifier
1215996301
Registry record updated Aug 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
036121222 Issued in IL
Practice address
3800 W 203Rd St
Suite 202
Olympia Fields, IL 60461-1184
Phone
(708) 679-2660
Fax
(708) 503-3861
NPI assigned
Mar 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 39423 KY
Pulmonary Disease Physician 207RP1001X 036121222 IL Primary

Addresses

Primary practice location

3800 W 203Rd St
Suite 202
Olympia Fields, IL 60461-1184

Mailing address

1040 Sierra Dr
Suite 400
Greenwood, IN 46143-7240
Phone (317) 528-4800

Other identifiers 6

IdentifierTypeStateIssuer
P00723355OtherILRAIL ROAD MEDICARE
05-0540914OtherILTAX ID
000000365405OtherKYBLUE CROSS BLUE SHIELD
64100852MedicaidKY
036121222MedicaidIL
P00256659OtherKYRAILROAD MEDICARE

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
I20090521000231 IL Practitioner - Internal MedicinePractitioner - Pulmonary DiseasePractitioner - Critical Care (Intensivists) 1456391937 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Critical Care (Intensivists)
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

580 Bankview Dr
Frankfort, IL 60423-1382
Phone (708) 475-5633

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
20.12 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
67.07

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036121222ILMDPulmonary Disease Physician
39423KYMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Consultant Physicians Pulmonary Disease CurrentSince Jul 1, 2020 Accepting new patients
Pulmonary and Sleep Associates Inc. CurrentSince Jan 26, 2014 Accepting new patients
Anand PSC Pulmonary Disease Past Accepting new patients

Locations

580 Bankview Dr
Frankfort, IL 60423
Phone (708) 475-5633

3800 W 203rd St
Ste 201
Olympia Flds, IL 60461

Interoperability endpoints

  • Direct secure messaging: pjain6004@direct.franciscanalliance.org

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 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": "1142812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377734400000",
    "number": "1215996301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 SIERRA DR",
            "address_2": "SUITE 400",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461437240",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-8319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 W 203RD ST",
            "address_2": "SUITE 202",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611184",
            "telephone_number": "708-679-2660",
            "fax_number": "708-503-3861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAIN",
        "first_name": "PANKAJ",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-20",
        "last_updated": "2013-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "KY",
            "license": "39423",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IL",
            "license": "036121222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P00723355",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "05-0540914",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000365405",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64100852",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036121222",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00256659",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia Fields, IL

Sources for this page

Verify at the official NPI Registry.