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DR. SANJAY K GARG M.B.B.S
NPI 1679594055
Pediatrics in Charleston, IL

Active since July 21, 2006PECOS Enrolled
116 W BUCHANAN AVE, CHARLESTON, IL 61920(217) 345-7700(217) 345-7200 Get Directions Write a Review

NPPES record last updated: July 6, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 6, 2023, Jan 22, 2021, Mar 18, 2016 (3 updates tracked since 2016).

About Dr. Sanjay K Garg M.b.b.s NPPES

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

DR. SANJAY K GARG M.B.B.S (NPI 1679594055) is an individual pediatrics provider in Charleston, Illinois, licensed in Illinois (036095041) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS and maintains a secondary practice location in Decatur.

NPPES Registry Identity

NPI1679594055
Entity TypeIndividualMale
Primary Taxonomy208000000X
Provider Legal NameDR. SANJAY K GARGCredential: M.B.B.S
Location Address116 W BUCHANAN AVECharleston, IL 61920-2522
Mailing AddressPo Box 372Mattoon, IL 61938-0372 · (217) 868-2812
Phone(217) 345-7700
Fax(217) 345-7200
Sole ProprietorNo
Enumeration DateJuly 21, 2006
Last NPPES UpdateJuly 6, 20233 updates tracked since enumeration
NPPES CertifiedJuly 6, 2023
✔ NPI 1679594055 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Licenses✔ Licensed in IL · 036095041✔ Licensed in IN · 01058382A
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.
116 W BUCHANAN AVE, Charleston, IL 61920
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Secondary Practice Location 1

Location 11730 E Lake Shore DrDecatur, IL 62521-3809 · Phone (217) 329-1000 · Fax (217) 329-1055

Other Identifiers 1

Medicaid200465180IN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware, CareSource.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 K Garg M.b.b.s 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 Reassignment

Medicare enrollment records show Sanjay Garg reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Sarah Bush Lincoln Health Center
4.9 mi
Family Medicine
1000 HEALTH CENTER DR
Mattoon, IL 61938
  • Reassigned Medicare billing, Illinois enrollment
  • 652 clinicians in this Medicare group
NPI 1568581379 (217) 258-2525

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 61920 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
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$97.25 typical visit price
range $17.16 – $136.56
Typical copayment $24.31 (range $4.29 – $34.14)
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 4

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

JOAN V ALVARADO MD
Family Medicine
116 W BUCHANAN AVE
CHARLESTON, IL 61920
Coles County (217) 345-7700
ERICA DAVIS PERRINO M.D.
Family Medicine
116 W BUCHANAN AVE
CHARLESTON, IL 61920
Coles County (217) 345-7700
MARK EMENECKER D.O.
Family Medicine
116 W BUCHANAN AVE
CHARLESTON, IL 61920
Coles County (217) 345-7700
DR. SEEMA GARG
Pediatrics
116 W BUCHANAN AVE
CHARLESTON, IL 61920
Coles County (217) 345-7700

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 Garg's NPI number?

The NPI number for Sanjay Garg is 1679594055. It was assigned to this individual provider in the NPPES registry on July 21, 2006.

Where is Sanjay Garg located?

Sanjay Garg practices at 116 W Buchanan Ave, Charleston, IL 61920. The listed phone number is (217) 345-7700.

What is Sanjay Garg's specialty?

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

Is Sanjay Garg enrolled in Medicare?

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

Which organization bills Medicare for Sanjay Garg's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Sanjay Garg reassigns Medicare benefits to Sarah Bush Lincoln Health Center (Mattoon, IL). The 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 Garg's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Sanjay Garg accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and CareSource list Sanjay Garg 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 Garg was last updated on July 6, 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.