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PRIYANSHI PATEL MD
NPI 1386200509
Pediatrics in Newark, OH

Active since May 13, 2019PECOS Enrolled
399 E MAIN ST, NEWARK, OH 43055(220) 564-1840(220) 564-1841 Get Directions Write a Review

NPPES record last updated: September 15, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 6, 2020, Apr 14, 2020, May 13, 2019 (3 updates tracked since 2019).

About Priyanshi Patel Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRIYANSHI PATEL MD (NPI 1386200509) is an individual pediatrics provider in Newark, Ohio, licensed in Ohio (57.249960) and active in the NPI registry since May 2019. She is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2020).

NPPES Registry Identity

NPI1386200509
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NamePRIYANSHI PATELCredential: MD
Location Address399 E MAIN STNewark, OH 43055-6516
Mailing Address399 E Main StNewark, OH 43055-6516 · (220) 564-1840 · Fax (220) 564-1841
Phone(220) 564-1840
Fax(220) 564-1841
Sole ProprietorNo
Medical School CMSOtherGraduated 2020
Enumeration DateMay 13, 2019
Last NPPES UpdateSeptember 15, 20233 updates tracked since enumeration
NPPES CertifiedSeptember 15, 2023
✔ NPI 1386200509 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in OH · 57.249960
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
399 E MAIN ST, Newark, OH 43055
Open in Google Maps ↗

Secondary Practice Locations 2

Location 1700 Childrens DrColumbus, OH 43205-2664 · Phone (614) 722-4411
Location 210563 Bermuda Isle DrTampa, FL 33647-2719 · Phone (813) 997-9074

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Antidote Health Plan of Ohio, Inc., CareSource and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Priyanshi Patel Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3072936129
PECOS Enrollment IDI20251205003680
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Priyanshi Patel reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Nationwide Children's Hospital
31 mi
Multi-Specialty
700 CHILDRENS DR
Columbus, OH 43205
  • Reassigned Medicare billing, Ohio enrollment
  • 976 clinicians in this Medicare group
NPI 1851179873 (614) 722-2055
Pediatric Academic Association, Inc.
31 mi
Pediatrics
700 CHILDRENS DR
Columbus, OH 43205
  • Reassigned Medicare billing, Ohio enrollment
  • 1,246 clinicians in this Medicare group
NPI 1063419943 (614) 722-4579

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 43055 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.72 typical visit price
range $54.34 – $166.65
Typical copayment $21.18 (range $13.58 – $41.66)
Most-billed visit code 99203
Established Patient
$96.44 typical visit price
range $17.10 – $135.40
Typical copayment $24.11 (range $4.27 – $33.85)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LICKING MEMORIAL PROFESSIONAL CORP
Family Medicine
399 E MAIN ST
NEWARK, OH 43055
Licking County (740) 348-1849
KATRINA M TIMSON MD
Family Medicine
399 E MAIN ST
NEWARK, OH 43055
Licking County (220) 564-1846
HANNAH ELIZABETH STEPHEN
Pediatrics
399 E MAIN ST
NEWARK, OH 43055
Licking County (220) 564-1840
LICKING MEMORIAL PROFESSIONAL CORP.
Pediatrics
399 E MAIN ST
NEWARK, OH 43055
Licking County (740) 348-1840
AMANDA LEIGH DAY APRN
Nurse Practitioner (Pediatrics)
399 E MAIN ST
NEWARK, OH 43055
Licking County (220) 564-1840
DR. DIANE LEMAY MD
Pediatrics
399 E MAIN ST
NEWARK, OH 43055
Licking County (740) 348-1840
ERIKA FORGRAVE
Speech-Language Pathologist
399 E MAIN ST
NEWARK, OH 43055
Licking County (614) 355-9779

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Priyanshi Patel's NPI number?

The NPI number for Priyanshi Patel is 1386200509. It was assigned to this individual provider in the NPPES registry on May 13, 2019.

Where is Priyanshi Patel located?

Priyanshi Patel practices at 399 E Main St, Newark, OH 43055. The listed phone number is (220) 564-1840.

What is Priyanshi Patel's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Priyanshi Patel enrolled in Medicare?

Yes. Priyanshi Patel is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Priyanshi Patel's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Priyanshi Patel reassigns Medicare benefits to 2 organizations: Nationwide Children's Hospital (Columbus, OH) and Pediatric Academic Association, Inc. (Columbus, OH). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Priyanshi Patel's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Priyanshi Patel accept?

Health plans from Anthem Blue Cross and Blue Shield, Antidote Health Plan of Ohio, Inc., CareSource, MedMutual and Molina Healthcare list Priyanshi Patel as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Priyanshi Patel was last updated on September 15, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.