NPIMap

Organization Active NPI

Sanjay Pethkar, M.D., S. C.

  • Internal Medicine Physician
  • Plainfield, IL
National Provider Identifier
1588873293
Registry record updated Oct 31, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036091255 Issued in IL
Legal business name
SANJAY PETHKAR, M.D., S. C.
Practice address
13415 S Route 59
Plainfield, IL 60585-5676
Phone
(815) 609-3627
Fax
(815) 609-1328
NPI assigned
May 21, 2007
Last updated
Oct 31, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2007

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

Authorized official

Name
Dr. Sanjay Pethkar, M.D.NPI 1134181829
Title
President
Phone
(815) 609-3627

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036091255 IL Primary

Addresses

Primary practice location

13415 S Route 59
Plainfield, IL 60585-5676

Mailing address

PO Box 9200
Naperville, IL 60567-0200
Phone (815) 609-3627

Other names 1

  • Suburban Healthcare Associates Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070911000423 IL Part B Supplier - Clinic/Group Practice 9830282565 Receives reassigned benefits from 5 practitioners
Practice locations: Joliet, IL; Naperville, IL; Plainfield, IL; Plano, IL

National Provider Directory

National Provider Directory

Locations

1421 Essington Rd
Joliet, IL 60435
Phone (815) 729-3627

2776 Forgue Dr
Ste 100
Naperville, IL 60564
Phone (331) 229-3210

13415 S Route 59
Plainfield, IL 60585
Phone (815) 274-6688

11000 US Highway 34
Ste 1
Plano, IL 60545
Phone (630) 332-4033

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193788800000",
    "number": "1588873293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9200",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605670200",
            "telephone_number": "815-609-3627",
            "fax_number": "815-609-1328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13415 S ROUTE 59",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605855676",
            "telephone_number": "815-609-3627",
            "fax_number": "815-609-1328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANJAY PETHKAR, M.D., S. C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2007-10-31",
        "status": "A",
        "authorized_official_last_name": "PETHKAR",
        "authorized_official_first_name": "SANJAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-609-3627",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036091255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suburban Healthcare Associates",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Plainfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2007; 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.