NPIMap

Individual provider Active NPI

Manisha S Patwardhan, M.D.

  • Adolescent Medicine (Internal Medicine) Physician
  • Chesterfield, MO
National Provider Identifier
1790755536
Registry record updated Dec 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0000X
License
2000169533 Issued in MO
Practice address
14314 Manderleigh Woods Dr
Chesterfield, MO 63017-8055
Phone
(636) 566-8155
Fax
(314) 566-8732
NPI assigned
Jan 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent Medicine (Internal Medicine) Physician 207RA0000X 2000169533 MO Primary

Addresses

Primary practice location

14314 Manderleigh Woods Dr
Chesterfield, MO 63017-8055

Mailing address

PO Box 958946
Saint Louis, MO 63195-8946
Phone (636) 566-8155

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20040609000243 MO Practitioner - Internal MedicinePractitioner - Geriatric Medicine 5193708410 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Medicine Group LLCGroup PAC ID 4385803931, 2 clinicians

Practice addresses (Care Compare)

1015 Bowles Ave
Fenton, MO 63026-2394
Phone (636) 496-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
58.31 of 100Reported as group
Quality
0
Improvement activities
40
Cost
73.75

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Medicine Group, LLC CurrentSince Dec 10, 2011 Accepting new patients
Inpatient Consultants of Missouri Inc Past Accepting new patients
Garden View Care Center of St. Louis, Inc. Past Accepting new patients
Mount Carmel Communities O'Fallon, LLC Past Accepting new patients
Mount Carmel Communities, LLC Past Accepting new patients
Sanjay a. Patwardhan, MD, PC Past Accepting new patients

Locations

167 Lamp and Lantern Vlg
Chesterfield, MO 63017
Phone (314) 729-1717

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

723 1st Capitol Dr
Saint Charles, MO 63301
Phone (504) 835-4919

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Abbey Senior HealthO Fallon, MO, CCN 265839 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 1, 2020
Jul 1, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 and National Provider Directory roles.

Hospital & facility affiliations 12

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

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": "1324252800000",
    "number": "1790755536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 958946",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631958946",
            "telephone_number": "636-566-8155",
            "fax_number": "314-566-8732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14314 MANDERLEIGH WOODS DR",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630178055",
            "telephone_number": "636-566-8155",
            "fax_number": "314-566-8732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATWARDHAN",
        "first_name": "MANISHA",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-24",
        "last_updated": "2011-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RA0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": "MO",
            "license": "2000169533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

Verify at the official NPI Registry.