Individual provider Active NPI

Pankaj K Kaul, M.D.

  • Internal Medicine Physician
  • Belleville, IL
National Provider Identifier
1376771105
Registry record updated Nov 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036125153 Issued in IL
Practice address
211 S 3Rd St
Belleville, IL 62220-1915
Phone
(618) 234-2120
Fax
(618) 641-5806
NPI assigned
Jul 1, 2009
Last updated
Nov 11, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 54712-20 WI
Hospitalist Physician 208M00000X 036125153 IL
Hospitalist Physician 208M00000X 2015038767 MO
Internal Medicine Physician 207R00000X 036125153 IL Primary

Addresses

Primary practice location

211 S 3Rd St
Belleville, IL 62220-1915

Mailing address

211 S 3Rd St
Belleville, IL 62220-1915
Phone (618) 234-2120

Other practice location 1

4500 Memorial Dr
Belleville, IL 62226-5360
Phone (618) 257-6220

Other identifiers 1

IdentifierTypeStateIssuer
P01162008OtherRR MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, IL, MO, GA4 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 4

Enrollment IDStateProvider typePAC IDDetails
I20101025001345 WI Practitioner - HospitalistPractitioner - Internal Medicine 8123211919 Reassigns benefits to 6 organizations
I20130110000495 IL Practitioner - Internal MedicinePractitioner - Hospitalist 8123211919 Reassigns benefits to 3 organizations
I20160115000724 MO Practitioner - HospitalistPractitioner - Internal Medicine 8123211919 Reassigns benefits to 4 organizations
I20161006001769 GA Practitioner - Internal Medicine 8123211919 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
54712-20WIMDInternal Medicine Physician
036125153ILMDHospitalist Physician
2015038767MOMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - Illinois SNF LLP Internal Medicine CurrentSince May 1, 2020 Accepting new patients
Sound Physicians of Illinois, LLC Internal Medicine CurrentSince Aug 9, 2017 Accepting new patients
Fairview Heights Medical Group SC CurrentSince Dec 22, 2022 Accepting new patients
Cep America - Illinois SNF, LLP Internal Medicine Current Accepting new patients
Cep America-Illinois Hospitalists, LLP Internal Medicine CurrentSince Mar 14, 2018 Accepting new patients
Lafayette County CurrentSince Oct 1, 2022 Accepting new patients
Edgerton Hospital and Health Services Inc. CurrentSince Dec 20, 2022 Accepting new patients
Baldwin Area Medical Center Inc. CurrentSince Jan 1, 2023 Accepting new patients
Galen Inpatient Physicians PC Hospitalist CurrentSince Oct 31, 2019 Accepting new patients
SSM Health Care St Louis CurrentSince Jul 1, 2019 Accepting new patients
Lafayette County CurrentSince Oct 1, 2022 Accepting new patients
Baldwin Area Medical Center, Inc. CurrentSince Jan 1, 2023 Accepting new patients
Galen Inpatient Physicians PC. Internal Medicine CurrentSince Oct 31, 2019 Accepting new patients
Cogent Healthcare of Georgia PC Internal Medicine CurrentSince Oct 1, 2022 Accepting new patients
Union Hospital Inc. Current Accepting new patients
Cep America-Illinois Hospitalists Hospitalist CurrentSince Mar 14, 2018 Accepting new patients
Fairview Heights Medical Group SC CurrentSince Dec 22, 2022 Accepting new patients
Lafayette County Current Accepting new patients
Adventist Health System Georgia Inc CurrentSince Jan 19, 2023 Accepting new patients
Cogent Healthcare of Missouri, Inc CurrentSince Jan 1, 2022 Accepting new patients
Cep America-Illinois Hospitalists, LLP Internal Medicine Current Accepting new patients
Hightower Physician Services, PC Hospitalist CurrentSince May 15, 2018 Accepting new patients
Cep America - Illinois SNF, LLP Internal Medicine CurrentSince May 1, 2020 Accepting new patients
Edgerton Hospital and Health Services, Inc CurrentSince Dec 20, 2022 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients
Edgerton Hospital and Health Services, Inc. Past Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 350-2663

1035 Red Bud Rd NE
Calhoun, GA 30701
Phone (706) 602-7800

707 Old Dalton Ellijay Rd
Chatsworth, GA 30705
Phone (706) 517-2050

1170 Cleveland Ave
East Point, GA 30344
Phone (404) 305-3500

4700 Waters Ave
Savannah, GA 31404
Phone (912) 273-1100

801 W Gordon St
Thomaston, GA 30286
Phone (706) 647-4371

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

1 Saint Anthonys Way
Alton, IL 62002
Phone (618) 233-6870

1021 W E St
Belleville, IL 62220
Phone (618) 233-2095

211 S 3rd St
Belleville, IL 62220
Phone (618) 234-2700

4500 Memorial Dr
Belleville, IL 62226
Phone (618) 233-7750

7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189

1623 W Delmar Ave
Godfrey, IL 62035
Phone (618) 466-0443

1 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone 618234212012438

12303 De Paul Dr
Bridgeton, MO 63044
Phone (314) 344-6360

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

100 Medical Plz
Lake St Louis, MO 63367
Phone (636) 625-5200

300 1st Capitol Dr
Saint Charles, MO 63301
Phone (636) 669-2211

6420 Clayton Rd
Saint Louis, MO 63117
Phone (314) 768-8442

1100 Bergslien St
Baldwin, WI 54002
Phone (715) 684-1111

211 Bev Anderson Dr
Darlington, WI 53530
Phone (608) 776-4466

800 Clay St
Darlington, WI 53530
Phone (608) 776-4466

11101 N Sherman Rd
Edgerton, WI 53534
Phone (608) 884-1695

831 Arthur Dr
Milton, WI 53563
Phone (608) 868-3526

Interoperability endpoints

  • Direct secure messaging: pkaul@unionhealth.cernerdirect.com
  • Direct secure messaging: pkaul201431@direct-ehr-ssmhc.com

Organizations & group practices 26

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668124800000",
    "number": "1376771105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 S 3RD ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622201915",
            "telephone_number": "618-234-2120",
            "fax_number": "618-641-5806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 S 3RD ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622201915",
            "telephone_number": "618-234-2120",
            "fax_number": "618-641-5806"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4500 Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "Belleville",
            "state": "IL",
            "postal_code": "622265360",
            "country_code": "US",
            "telephone_number": "618-257-6220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAUL",
        "first_name": "PANKAJ",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-01",
        "last_updated": "2022-11-11",
        "certification_date": "2022-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "54712-20",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036125153",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MO",
            "license": "2015038767",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036125153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01162008",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4500 Memorial Dr",
            "city": "Belleville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622265360",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

Verify at the official NPI Registry.