Individual provider Active NPI

Sidak Pannu, M.D.

  • Vascular & Interventional Radiology Physician
  • Springfield, MA
National Provider Identifier
1326402728
Registry record updated Nov 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
1014931 Issued in MA
Practice address
3500 Main St Ste 201
Springfield, MA 01107-1150
Phone
(413) 794-0900
Fax
(413) 794-2996
NPI assigned
Apr 12, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 22677 NH
Vascular & Interventional Radiology Physician 2085R0204X 1014931 MA Primary

Addresses

Primary practice location

3500 Main St Ste 201
Springfield, MA 01107-1150

Mailing address

280 Chestnut Street
2ND Floor
Springfield, MA 01199-1001
Phone (413) 794-5700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH, MA2 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
I20220726003402 NH Practitioner - Interventional Radiology 0244527950 Reassigns benefits to 1 organization
I20230522003198 MA Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 0244527950 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional RadiologyAlso: Diagnostic Radiology
Education
George Washington University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baystate Medical Practices IncGroup PAC ID 5991602971, 1,350 clinicians

Practice addresses (Care Compare)

3500 Main St
Springfield, MA 01107-1137
Phone (413) 794-0900

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
22677NHMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baystate Medical Practices, Inc CurrentSince May 12, 2023 Accepting new patients
Dartmouth-Hitchcock Clinic Diagnostic Radiology CurrentSince Jul 25, 2022 Accepting new patients

Locations

3500 Main St
Ste 201
Springfield, MA 01107
Phone (413) 784-0900

759 Chestnut St
Springfield, MA 01199
Phone (413) 794-3233

3500 Main St
Springfield, MA 01107
Phone (413) 784-0900

280 Chestnut St
Fl 2
Springfield, MA 01199
Phone (413) 788-4385

1 Medical Dr
Lebanon, NH 03756
Phone (603) 650-5922

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": "1460419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1326402728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 CHESTNUT STREET",
            "address_2": "2ND FLOOR",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011991001",
            "telephone_number": "413-794-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 MAIN ST STE 201",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011071150",
            "telephone_number": "413-794-0900",
            "fax_number": "413-794-2996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANNU",
        "first_name": "SIDAK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-12",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NH",
            "license": "22677",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "MA",
            "license": "1014931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MA

Sources for this page

Verify at the official NPI Registry.