NPIMap

Individual provider Active NPI

Samir Bipin Pancholy, M.D.

  • Interventional Cardiology Physician
  • Clarks Summit, PA
National Provider Identifier
1609846674
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
MD045919L Issued in PA
Practice address
401 N State St
Clarks Summit, PA 18411-1061
Phone
(570) 587-7817
Fax
(570) 587-7815
NPI assigned
Jan 24, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X MD045919L PA
Interventional Cardiology Physician 207RI0011X MD045919L PA Primary

Addresses

Primary practice location

401 N State St
Clarks Summit, PA 18411-1061

Mailing address

PO Box 620
Chinchilla, PA 18410-0620
Phone (570) 587-7817

Other identifiers 3

IdentifierTypeStateIssuer
001584853MedicaidPA
801519OtherPAFIRST PRIORITY HEALTH
23711OtherPAGEISINGER HEALTH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20070220000204 PA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 9436251501 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Wright Center Medical GroupGroup PAC ID 6305841230, 38 clinicians
Wayne Memorial HospitalGroup PAC ID 4082522149, 52 clinicians

Practice addresses (Care Compare)

401 N State St
Clarks Summit, PA 18411-1061
Phone (570) 587-7817

5 S Washington Ave
Jermyn, PA 18433-1121
Phone (570) 230-0019

601 Park St
Honesdale, PA 18431-1445
Phone (570) 253-8101

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
43.57 of 100Reported as group
Quality
87.14
Improvement activities
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting15
Pacemaker insertion or repair17

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD045919LPAMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wayne Memorial Hospital Interventional Cardiology CurrentSince Jul 1, 2025 Accepting new patients
The Wright Center Medical Group Current Accepting new patients
Wayne Memorial Hospital CurrentSince Jul 1, 2025 Accepting new patients
The Wright Center Medical Group Cardiovascular Disease CurrentSince Jan 1, 2025 Accepting new patients
Samir B Pancholy LLC Cardiovascular Disease CurrentSince Feb 6, 2007 Accepting new patients
Raphael Heart Group. P.C. Cardiovascular Disease Past Accepting new patients

Locations

401 N State St
Clarks Summit, PA 18411
Phone (570) 587-7817

260 Daleville Hwy
Ste 103
Covington Township, PA 18444
Phone (570) 591-5150

103 Spruce St
Hawley, PA 18428
Phone (570) 390-4545

1855 Fair Ave
Lowr
Honesdale, PA 18431
Phone (570) 253-3980

601 Park St
Honesdale, PA 18431
Phone (570) 253-8100

5 S Washington Ave
Jermyn, PA 18433
Phone (570) 230-0019

1401 Fellows St
Scranton, PA 18504
Phone (570) 591-5280

200 Wyoming Ave
#250
Scranton, PA 18503
Phone (570) 342-5253

312 Boulevard Ave
Scranton, PA 18519
Phone (570) 489-4567

329 Cherry St
Scranton, PA 18505
Phone (570) 348-6100

501 S Washington Ave
Scranton, PA 18505
Phone (570) 591-5153

501 S Washington Ave
Ste 1000
Scranton, PA 18505
Phone (570) 866-3058

1145 Northern Blvd
South Abington Township, PA 18411
Phone (570) 493-1335

169 N Pennsylvania Ave
Wilkes Barre, PA 18701
Phone (570) 346-8147

Interoperability endpoints

  • Direct secure messaging: samir.pancholy.1@30200.direct.athenahealth.com
  • Direct secure messaging: spancholy@thewrightcenter.medentdirect.com

Organizations & group practices 6

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.

Hospital & facility affiliations 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1609846674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 620",
            "city": "CHINCHILLA",
            "state": "PA",
            "postal_code": "184100620",
            "telephone_number": "570-587-7817",
            "fax_number": "570-587-7815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N STATE ST",
            "city": "CLARKS SUMMIT",
            "state": "PA",
            "postal_code": "184111061",
            "telephone_number": "570-587-7817",
            "fax_number": "570-587-7815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANCHOLY",
        "first_name": "SAMIR",
        "middle_name": "BIPIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "PA",
            "license": "MD045919L",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "PA",
            "license": "MD045919L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001584853",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY HEALTH",
            "identifier": "801519",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER HEALTH",
            "identifier": "23711",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarks Summit, PA

Sources for this page

Verify at the official NPI Registry.