SANJAY POUDEL MBBS
NPI 1972164853
Internal Medicine in Providence, RI

Q: What is Sanjay Poudel's NPI number?

The NPI number for Sanjay Poudel is 1972164853. It was assigned to this individual provider in the NPPES registry on June 22, 2019.

Q: What is Sanjay Poudel's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Q: When was this NPI record last updated?

The NPPES record for Sanjay Poudel was last updated on June 17, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.

Active since June 22, 2019PECOS EnrolledAccepts Medicare Assignment

164 SUMMIT AVE, PROVIDENCE, RI 02906(401) 793-4489 Get Directions Write a Review

NPPES record last updated: June 17, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Sanjay Poudel Mbbs NPPES

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

SANJAY POUDEL MBBS (NPI 1972164853) is an individual internal medicine provider in Providence, Rhode Island, licensed in Rhode Island (MD18349) and active in the NPI registry since June 2019. He is enrolled in Medicare PECOS, is affiliated with Metrowest Medical Center, and maintains a secondary practice location in Baltimore.

NPPES Registry Identity

NPI1972164853

Entity TypeIndividualMale

Primary Taxonomy207R00000X

Provider Legal NameSANJAY POUDELCredential: MBBS

Location Address164 SUMMIT AVEProvidence, RI 02906-2894

Mailing Address117 Ellenfield St Ste 101Providence, RI 02905-4541 · (401) 444-6779

Phone(401) 793-4489

Sole ProprietorYes

Medical School CMSOtherGraduated 2016

Enumeration DateJune 22, 2019

Last NPPES UpdateJune 17, 2022

NPPES CertifiedJune 17, 2022

✔ NPI 1972164853 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

License✔ Licensed in RI · MD18349

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

164 SUMMIT AVE, Providence, RI 02906

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Secondary Practice Location 1

Location 12401 W Belvedere AveBaltimore, MD 21215-5270 · Phone (410) 601-7639

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Sanjay Poudel Mbbs is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4688900996

PECOS Enrollment IDI20220809003053, I20250818003722

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

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

Lifespan Physician Group Inc

0.4 mi

Urology

195 COLLYER ST STE 201
Providence, RI 02904

Reassigned Medicare billing, Rhode Island enrollment
1,372 clinicians in this Medicare group

NPI 1720949803 (401) 272-7799

Hospitalist Physicians Of Massachusetts PC

30 mi

Hospitalist

115 LINCOLN ST
Framingham, MA 01702

Reassigned Medicare billing, Massachusetts enrollment
156 clinicians in this Medicare group

NPI 1376145680 (508) 383-1000

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

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

117 services60 patients

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233

Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.

100 services63 patients

Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223

Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.

43 services43 patients

Hospital discharge day management, 30 minutes or less 99238

Hospital discharge day management of 30 minutes or less includes finalizing your treatment, discussing your progress, and planning after-care at home. It ensures you're ready to leave the hospital and continue recovery safely.

28 services28 patients

Hospital discharge day management, more than 30 minutes 99239

Hospital discharge day management over 30 minutes involves a detailed process to ensure a smooth transition from hospital to home. It includes final examinations, discussion of your hospital stay, post-discharge instructions, and coordinating follow-up care.

25 services25 patients

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

15 services15 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Metrowest Medical Center

Acute Care Hospitals · Framingham, MA

2/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number220175

Location115 Lincoln StreetFramingham, MA 01701 · Middlesex County

Emergency services Birthing friendly

St Vincent Hospital

Acute Care Hospitals · Worcester, MA

2/5 CMS rating

OwnershipProprietary

CMS Certification Number220176

Location123 Summer StreetWorcester, MA 01608 · Worcester County

Emergency services Birthing friendly

The Miriam Hospital

Acute Care Hospitals · Providence, RI

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number410012

Location164 Summit AvenueProvidence, RI 02906 · Providence County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 02906 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

$134.17 typical visit price

range $58.57 – $177.03

Typical copayment $33.54 (range $14.64 – $44.25)

Most-billed visit code 99204

Established Patient

$103.10 typical visit price

range $18.92 – $144.38

Typical copayment $25.77 (range $4.73 – $36.09)

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 20

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

MRS. HALINA KUC-MAZGAJ

Nurse Practitioner (Family)

164 SUMMIT AVE, THE MIRIAM HOSPITAL
PROVIDENCE, RI 02906

Providence County (401) 793-3902

KARL HERMAN M.D.

Internal Medicine

164 SUMMIT AVE, FAIN BLDG.
PROVIDENCE, RI 02906

Providence County (401) 793-4489

MUHAMMAD BAIG M.D.

Internal Medicine (Cardiovascular Disease)

164 SUMMIT AVE, FAIN BLDG
PROVIDENCE, RI 02906

Providence County (401) 793-4489

MS. LEANNE LAPARLE LICSW

Social Worker (Clinical)