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DR. SANJAY KUMAR M.D.
NPI 1457665671
Pediatrics - Pediatric Gastroenterology in Detroit, MI

Active since July 29, 2010PECOS Enrolled
22201 MOROSS ROAD, SUITE 270, PBII, DETROIT, MI 48236(313) 343-3481(313) 343-7937 Get Directions Write a Review

NPPES record last updated: November 22, 2016. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Sanjay Kumar M.d. NPPES

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

DR. SANJAY KUMAR M.D. (NPI 1457665671) is an individual pediatric gastroenterology provider in Detroit, Michigan, licensed in Michigan (4301096546) and active in the NPI registry since July 2010. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1457665671
Entity TypeIndividualMale
Primary Taxonomy2080P0206X
Provider Legal NameDR. SANJAY KUMARCredential: M.D.
Location Address22201 MOROSS ROAD, SUITE 270, PBIIDetroit, MI 48236
Mailing Address22201 Moross Road, Suite 270, PbiiDetroit, MI 48236 · (313) 343-3481 · Fax (313) 343-7937
Phone(313) 343-3481
Fax(313) 343-7937
Sole ProprietorNo
Enumeration DateJuly 29, 2010
Last NPPES UpdateNovember 22, 2016
✔ NPI 1457665671 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Pediatric GastroenterologyAllopathic & Osteopathic Physicians
Taxonomy Code2080P0206X
License✔ Licensed in MI · 4301096546
Definition
A pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs.
22201 MOROSS ROAD, Detroit, MI 48236
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health 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)

Dr. Sanjay Kumar M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Sanjay Kumar reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Ascension St John Hospital
Same address
Neurology
22101 MOROSS RD
Detroit, MI 48236
  • Reassigned Medicare billing, Michigan enrollment
  • Medicare enrollment name: Henry Ford Health St. John Hospital
  • 520 clinicians in this Medicare group
NPI 1023149473 (586) 753-0011
Henry Ford Health Macomb-Oakland Hospital
7.5 mi
Family Medicine
11800 E 12 MILE RD
Warren, MI 48093
  • Reassigned Medicare billing, Michigan enrollment
  • 161 clinicians in this Medicare group
NPI 1134176472 (586) 573-5000

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 48236 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
$134.28 typical visit price
range $58.04 – $177.36
Typical copayment $33.57 (range $14.51 – $44.34)
Most-billed visit code 99204
Established Patient
$102.35 typical visit price
range $18.32 – $143.49
Typical copayment $25.58 (range $4.58 – $35.87)
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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

Reported Quality Measures

e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
93%622 patients4/55-star benchmark: 99%
Medication Reconciliation
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
99%537 patients4/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
59%829 patients3/55-star benchmark: 97%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
58%31 patients3/55-star benchmark: 97%
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
75%829 patients4/55-star benchmark: 100%
Secure Messaging
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…
40%829 patients2/55-star benchmark: 89%
View, Download, or Transmit (VDT)
At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period.
31%829 patients
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Other Providers at the Same Location NPPES 4

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

DR. SANJAY BATRA MD
Thoracic Surgery (Cardiothoracic Vascular Surgery)
22201 MOROSS ROAD, SUITE 356
DETROIT, MI 48236
Wayne County (313) 343-7444
JASON VALENCIA M.D.
Student in an Organized Health Care Education/Training Program
22201 MOROSS ROAD, ANESTHESIOLOGY DEPARTMENT
DETROIT, MI 48236
Wayne County (313) 343-6530
LARRY LEITCH-CASEY M.D.
Student in an Organized Health Care Education/Training Program
22201 MOROSS ROAD, SUITE 50
DETROIT, MI 48236
Wayne County (313) 343-7774
DR. JAMES MICHAEL RENIER DPM
Podiatrist (Foot & Ankle Surgery)
22201 MOROSS ROAD, SUITE 250 PROFESSIONAL BUILDING 2
DETROIT, MI 48236
Wayne County (313) 343-3423

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 Sanjay Kumar's NPI number?

The NPI number for Sanjay Kumar is 1457665671. It was assigned to this individual provider in the NPPES registry on July 29, 2010.

Where is Sanjay Kumar located?

Sanjay Kumar practices at 22201 Moross Road Suite 270, Pbii, Detroit, MI 48236. The listed phone number is (313) 343-3481.

What is Sanjay Kumar's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Gastroenterology, with taxonomy code 2080P0206X.

Is Sanjay Kumar enrolled in Medicare?

Yes. Sanjay Kumar is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Sanjay Kumar's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Sanjay Kumar reassigns Medicare benefits to 2 organizations: Ascension St John Hospital (Detroit, MI) and Henry Ford Health Macomb-Oakland Hospital (Warren, MI). 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 Sanjay Kumar's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Sanjay Kumar accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company and 1 other insurer list Sanjay Kumar 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 Sanjay Kumar was last updated on November 22, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.