NPIMap

Individual provider Active NPI

Sanjiv Gollakota, DO

  • Internal Medicine Physician
  • Greenwood, IN
National Provider Identifier
1568845220
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OT016591 Issued in PA
Practice address
3000 S State Road 135 Ste 310
Greenwood, IN 46143
Phone
(317) 497-2400
Fax
(317) 497-2515
NPI assigned
Jun 30, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 27, 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 OT016591 PA Primary

Addresses

Primary practice location

3000 S State Road 135 Ste 310
Greenwood, IN 46143

Mailing address

6626 E 75TH St Ste 500
Indianapolis, IN 46250-2890
Phone (317) 621-9312

Other practice location 1

5515 Peach St
Erie, PA 16509-2603
Phone (304) 216-3511

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sgollakota316340@eCommunityDirect.com Community Physicians of Indiana Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20230726003390 CT Practitioner - Internal Medicine 3577818095 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
West Virginia School of Osteopathic Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northeast Medical Group IncGroup PAC ID 1254233836, 1,357 clinicians

Practice addresses (Care Compare)

5 Pequot Park Rd
Westbrook, CT 06498-2856
Phone (860) 399-6167

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
86.54
Promoting interoperability
99.98
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OT016591PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mill Hill Medical Consultants Inc CurrentSince Aug 28, 2023 Accepting new patients
Northeast Medical Group, Inc. Internal Medicine CurrentSince Aug 28, 2023 Accepting new patients
Internal Medicine of Clinton, LLC PastSince Oct 15, 2003 Accepting new patients

Locations

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

5 Pequot Park Rd
Westbrook, CT 06498
Phone (860) 339-3350

5 Pequot Park Rd
Ste 301
Westbrook, CT 06498
Phone (860) 399-6167

Interoperability endpoints

  • Direct secure messaging: sgollakota316340@ecommunitydirect.com
  • Direct secure messaging: sgollakota623534@direct.ynhh.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 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1435622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1568845220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 E 75TH ST STE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502890",
            "telephone_number": "317-621-9312",
            "fax_number": "317-621-6920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 S STATE ROAD 135 STE 310",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "46143",
            "telephone_number": "317-497-2400",
            "fax_number": "317-497-2515"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5515 Peach St",
            "address_purpose": "LOCATION",
            "city": "Erie",
            "state": "PA",
            "postal_code": "165092603",
            "country_code": "US",
            "telephone_number": "304-216-3511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOLLAKOTA",
        "first_name": "SANJIV",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-30",
        "last_updated": "2023-11-27",
        "certification_date": "2023-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OT016591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sgollakota316340@eCommunityDirect.com",
            "affiliation": "Y",
            "affiliationName": "Community Physicians of Indiana Inc",
            "address_1": "3000 S State Road 135 Ste 310",
            "city": "Greenwood",
            "state": "IN",
            "country_code": "US",
            "postal_code": "46143",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenwood, IN

Sources for this page

Verify at the official NPI Registry.