Sanjay Suryakant Pancholi, D.O.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036118253 Issued in IL

Practice address

2750 11TH St
Rock Island, IL 61201-5216

Phone

(563) 327-2100

Fax

(563) 327-2102

NPI assigned

May 24, 2007

Last updated

May 25, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL, IA2 enrollments

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 2

Specialty

Internal Medicine

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Genesis Health SystemGroup PAC ID 7214841436, 217 clinicians

Quad City Physical Therapy and SpineGroup PAC ID 1850332651, 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Genesis Vna Home health agency, Bettendorf, IA, CCN 167012
• Centerwell Home Health Home health agency, Moline, IL, CCN 147428
• Mercyone Genesis Hospice, Bettendorf, IA, CCN 161520
• Genesis HLTH System Dba Genesis MDL Ctr-Illini Hospital, Silvis, IL, CCN 140275
• Genesis Medical Center-Davenport Hospital, Davenport, IA, CCN 160033
• Trinity Rock Island Hospital, Rock Island, IL, CCN 140280
• Genesis Medical Center, Aledo Hospital, Aledo, IL, CCN 141304

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sanjay.pancholi@direct.genesishealth.com

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.

• Genesis Health System

  dba Genesis Health Group

  • Family Medicine Physician
  • Davenport, IA
  • NPI 1477654945

  IL, Internal Medicine

  Medicare reassignment Care Compare group NPD
• Genesis Health System

  dba Genesis Convenient Care Bettendorf

  • Clinic/Center
  • Bettendorf, IA
  • NPI 1497772008
  Medicare reassignment
• Quad City Physical Therapy & Spine

  • Physical Therapy Clinic/Center
  • Davenport, IA
  • NPI 1033166749
  Care Compare group
• Genesis Health System

  dba Genesis Medical Center Dewitt

  • Critical Access Hospital
  • De Witt, IA
  • NPI 1649368523
  NPD
• Genesis Health System

  dba Genesis Health Group

  • Family Medicine Physician
  • Moline, IL
  • NPI 1164538435
  NPD (past)

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

• Centerwell Certified Healthcare Corp.

  dba CenterWell Home Health

  • Home Health Agency
  • Moline, IL
  • NPI 1861428559
  Care Compare affiliation
• Genesis Health System

  dba Genesis Medical Center - Silvis

  • General Acute Care Hospital
  • Silvis, IL
  • NPI 1427132604
  Care Compare affiliation
• Genesis Medical Center, Aledo

  dba MercyOne Genesis Aledo Medical Center

  • Critical Access Hospital
  • Aledo, IL
  • NPI 1225380967
  Care Compare affiliation
• Trinity Medical Center

  dba Trinity Rock Island

  • General Acute Care Hospital
  • Rock Island, IL
  • NPI 1316047632
  Care Compare affiliation
• Genesis Health System

  dba Genesis Hospice

  • Community Based Hospice Care Agency
  • Bettendorf, IA
  • NPI 1013968262
  Care Compare affiliation
• Genesis Health System

  dba Genesis VNA and Hospice

  • Home Health Agency
  • Bettendorf, IA
  • NPI 1467404491
  Care Compare affiliation
• Genesis Health System

  dba Genesis Medical Center Davenport

  • General Acute Care Hospital
  • Davenport, IA
  • NPI 1972542264
  Care Compare affiliation

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621900800000",
    "number": "1780894816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W RIVER DR",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528011014",
            "telephone_number": "563-336-3000",
            "fax_number": "563-336-3125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 11TH ST",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612015216",
            "telephone_number": "563-327-2100",
            "fax_number": "563-327-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANCHOLI",
        "first_name": "SANJAY",
        "middle_name": "SURYAKANT",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-24",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036118253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036118253",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sanjay.pancholi@direct.genesishealth.com",
            "affiliation": "N",
            "endpointDescription": "genesis health system direct email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "ccda",
            "address_1": "3900 28th Avenue Dr Ste 200",
            "city": "Moline",
            "state": "IL",
            "country_code": "US",
            "postal_code": "612655540",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Valerie S Olson, LCPC
• Ora Orthopedics PC (ORA Orthopedics Physical Therapy)
• Outreach Homehealth Services, Inc.
• Outreach Medical, Inc.
• Gloria Pagan, MS CCC-SLP
• Caleb Paniamogan, DO
• Kerry P Panozzo, MD
• Albert Park, MD
• Stephane Gail Parker, LCPC
• La'Cretsia S Parrow

• Internal Medicine Physician in Rock Island, IL
• Providers in Rock Island, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.