Sujal V Panchal, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301106399 Issued in MI

Practice address

100 Batson CT
Suite 106
New Lenox, IL 60451-1564

Phone

(815) 463-9747

Fax

(815) 463-9749

NPI assigned

Sep 15, 2006

Last updated

Oct 19, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Sujal Fadia Former name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: spanchal383884@direct.hfhs.org

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.

• Henry Ford Health System

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1134144801
  Medicare reassignment NPD
• Henry Ford Health System

  dba Hnery Ford Health Sysytem

  • Pediatrics Physician
  • Detroit, MI
  • NPI 1003990318
  NPD
• Henry Ford Health System

  • Community/Retail Pharmacy
  • Plymouth, MI
  • NPI 1942931720
  NPD
• Azee Inc

  • Pediatrics Physician
  • New Lenox, IL
  • NPI 1811869753
  NPD (past)

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603065600000",
    "number": "1629174024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BATSON CT",
            "address_2": "SUITE 106",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604511564",
            "telephone_number": "815-463-9747",
            "fax_number": "815-463-9749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BATSON CT",
            "address_2": "SUITE 106",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604511564",
            "telephone_number": "815-463-9747",
            "fax_number": "815-463-9749"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6100 N Haggerty Rd",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "MI",
            "postal_code": "481873683",
            "country_code": "US",
            "telephone_number": "800-653-6568",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PANCHAL",
        "first_name": "SUJAL",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-15",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036119020",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A82152",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301106399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036119020",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP40248F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUJAL",
            "last_name": "FADIA",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Pediatrics Physician in New Lenox, IL
• Providers in New Lenox, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.