NPIMap

Individual provider Active NPI

Kanchan M. Pillai, M.D.

  • Internal Medicine Physician
  • Perrysburg, OH
National Provider Identifier
1568692655
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35099555 Issued in OH
Practice address
6175 Levis Commons Blvd Ste 104
Perrysburg, OH 43551-7269
Phone
(567) 585-0380
Fax
(567) 585-0381
NPI assigned
Jul 23, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35099555 OH Primary

Addresses

Primary practice location

6175 Levis Commons Blvd Ste 104
Perrysburg, OH 43551-7269

Mailing address

333 N Summit St FL 7
Toledo, OH 43604-1531

Other identifiers 2

IdentifierTypeStateIssuer
0069201MedicaidOH
35099555OtherOHOHIO MEDICAL LICENSE

Other names 1

  • Kanchan V. Landge Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kpillai29122@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20120813000221 OH Practitioner - Internal Medicine 3678729357 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Promedica Multi Specialty PhysiciansGroup PAC ID 7113182809, 269 clinicians

Practice addresses (Care Compare)

1601 Brigham Dr
Suite 200
Perrysburg, OH 43551-7117
Phone (567) 585-0380

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35099555OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians-North LLC Family Medicine CurrentSince Jul 4, 2012 Accepting new patients
Mercy Health Physicians - North, LLC CurrentSince Jul 4, 2012 Accepting new patients
The Toledo Hospital Past Accepting new patients
Bay Park Community Hospital Past Accepting new patients

Locations

715 S Taft Ave
Fremont, OH 43420
Phone (419) 332-7321

2200 Jefferson Ave
Fl 5
Toledo, OH 43604
Phone (419) 251-9826

2222 Cherry St
Ste 2300
Toledo, OH 43608
Phone (419) 251-8013

Interoperability endpoints

  • Direct secure messaging: kpillai29122@direct.promedica.org

Organizations & group practices 5

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 9

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": "1248307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1568692655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N SUMMIT ST FL 7",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6175 LEVIS COMMONS BLVD STE 104",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435517269",
            "telephone_number": "567-585-0380",
            "fax_number": "567-585-0381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PILLAI",
        "first_name": "KANCHAN",
        "middle_name": "M.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-23",
        "last_updated": "2023-11-03",
        "certification_date": "2023-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35099555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0069201",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO MEDICAL LICENSE",
            "identifier": "35099555",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kpillai29122@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KANCHAN",
            "last_name": "LANDGE",
            "middle_name": "V.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Perrysburg, OH

Sources for this page

Verify at the official NPI Registry.