Sujan Pathak, MD
Individual provider Active NPI Nephrology Physician · Rapid City, SD
NPI 1689864449 · NPPES record last updated Feb 6, 2013
Key facts
- NPI
- 1689864449
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nephrology Physician 207RN0300X
- License
- 8454 (SD)
- Practice address
- 640 Flormann St
Rapid City, SD 57701-4679 - Phone
- (605) 718-3300
- Fax
- (605) 718-3426
- NPI assigned
- Jul 27, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 13
Medicare Care Compare profile
- Specialty
- Nephrology
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Integris Ambulatory Care Corporation
Kidney Specialists of Central Oklahoma, PC
Practice addresses (Care Compare)
3300 NW Expressway
Oklahoma City, OK 73112-4418
Phone (405) 949-3141
3366 NW Expressway
Suite 550
Oklahoma City, OK 73112-4489
Phone (405) 942-5442
Hospital & facility affiliations
- Fmcna - Stillwater Medical Ctr Dialysis
- FKC - Lake Hefner Dialysis
- Fmcna - North Central Oklahoma City
- Fmcna - Edmond East
- Integris Baptist Medical Center, Inc
- Stillwater Medical Center
- Integris Health Edmond Hospital
- Integris Southwest Medical Center
- Integris Canadian Valley Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160429000379 | OK | Practitioner - Nephrology |
7214082098 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kidney Specialists of Central Oklahoma, PC | Nephrology | Current |
Accepting new patients |
| Integris Ambulatory Care Corporation | Current |
Accepting new patients | |
| Summit Medical Center | Past | Accepting new patients | |
| Jackson County Memorial Hospital Authority | Past | Accepting new patients |
Locations
4509 Integris Pkwy
Ste 220
Edmond, OK 73034
3366 NW Expressway St
Ste 550
Oklahoma City, OK 73112
Phone (405) 942-5442
3300 NW Expressway St
Oklahoma City, OK 73112
Phone (405) 251-2815
3400 NW Expressway
Ste 500
Oklahoma City, OK 73112
Phone (405) 945-4589
Interoperability endpoints
- spathak16076@direct.acumenmd.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 8454 | SD | Yes |
Addresses
Primary practice location
640 Flormann St
Rapid City, SD 57701-4679
Mailing address
353 Fairmont Blvd
Atten Medical Staff Services
Rapid City, SD 57701-6000
Other providers in Rapid City, SD
- Partner Medical HC RC LLC
- Darcy Paschke
- Gelynn Passmore
- Lance Patenode
- Rachel A Patenode
- Alan Ross Patterson
- Kendra Nicole Patton
- Marie S Patton
- Paul a Bormes MD PC
- Paul M. Rezich, DDS, PC
All providers in Rapid City, SD · Nephrology Physician in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.