NPIMap

Organization Active NPI

Pathology Associates of Central Illi

  • Anatomic Pathology & Clinical Pathology Physician
  • Greenville, IL
National Provider Identifier
1447402391
Registry record updated Oct 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
PATHOLOGY ASSOCIATES OF CENTRAL ILLI
Practice address
200 Healthcare Drive
Greenville, IL 62246-1154
Phone
(618) 664-1230
NPI assigned
Oct 22, 2008
Last updated
Oct 10, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2011

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

Authorized official

Name
Sanjai Nagendra, M.D.
Title
Medical Director
Phone
(586) 412-4379

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X Primary

Addresses

Primary practice location

200 Healthcare Drive
Greenville, IL 62246-1154

Mailing address

44000 Garfield Road
Clinton Township, MI 48038
Phone (586) 412-4379

Other identifiers 1

IdentifierTypeStateIssuer
CC5544OtherILRRMC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040428000745 IL Part B Supplier - Clinic/Group Practice 6103813449 Receives reassigned benefits from 18 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Taylorville, IL; Springfield, IL; Shelbyville, IL; Havana, IL; Decatur, IL; Jacksonville, IL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

44000 Garfield Rd
Clinton Twp, MI 48038
Phone (313) 343-1000

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1224633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318204800000",
    "number": "1447402391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44000 GARFIELD ROAD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "48038",
            "telephone_number": "586-412-4379",
            "fax_number": "586-412-4102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HEALTHCARE DRIVE",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622461154",
            "telephone_number": "618-664-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHOLOGY ASSOCIATES OF CENTRAL ILLI",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-22",
        "last_updated": "2011-10-10",
        "status": "A",
        "authorized_official_last_name": "NAGENDRA",
        "authorized_official_first_name": "SANJAI",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "586-412-4379",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC",
            "identifier": "CC5544",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.