JAY PAL

NPI 1396936548 · Cardiac Surgery · Anthem

Provider Status Assessment

Needs Review

Carrier listings present but Colorado DORA license appears expired or revoked.

Confidence: High

Evidence: 12573 items from 13 sources

Signals: 5 supporting · 1 opposing · 1 missing

Resolution: Carrier listings present but Colorado DORA license appears expired or revoked. Licensure concern outweighs network presence.

Data Source Signals

✓

NPPES

AURORA, 80045

Freshness: Unknown

✓

Network Status

Listed with 7 carriers

anthem_co — in_network (commercial)
anthem_co — in_network (commercial)
uhc_services_co — in_network (commercial)
uhc_colorado_co — in_network (commercial)
uhc_insurance_co — in_network (commercial)
uhc_umr_co — in_network (commercial)
uhc_surest_co — in_network (commercial)

✗

DORA License

Expired

✓

Medicare

86 services

34 beneficiaries

$64,413.3 total payment

Specialty: Cardiac Surgery

—

Care Compare

No Care Compare data

✓

PECOS Enrollment

Medicare enrolled

System Reasoning

Claim Under Evaluation

Provider is actively practicing and appropriately listed in carrier networks

Evidence Evaluated

Colorado DORA License: License status: Expired

FHIR Directory: No active FHIR endpoint despite carrier listings

NPPES Registry: Active NPI, registered in AURORA

Medicare Billing: 86 services, 34 beneficiaries

PECOS Enrollment: Medicare enrollment confirmed

Federal Exclusion Check: No federal exclusions found (OIG LEIE, SAM.gov)

Carrier Networks: Listed in 7 carrier networks

CMS Care Compare: Not found in CMS Care Compare

Trust Evaluation

identity:0.75Strong

licensure:0.20Critical

activity:1.00

Dimension Scores

Composite0.72

Identity0.75 — Moderate

Active NPI with specialty classification

Licensure0.20 — Critical

DORA license expired or revoked

Activity1.00 — Strong

Active Medicare billing confirmed

Reachability0.60 — Moderate

Single address source (NPPES)

Network1.00 — Strong

Listed in multiple carrier networks

Why is this provider classified as “needs review”?

Evidence across dimensions is contradictory or specific concerns exist (unverified license, FHIR directory contradiction). Manual review recommended.

Carrier Network Listings

6 networks across 2 carriers

Anthem(1 network)

1 DOI 6C-3

Anthem Blue Cross Blue ShieldDOI 6C-3

View carrier →

UnitedHealthcare(5 networks)

1 DOI 6C-34 Federal TiC

UnitedHealthcare ServicesFederal TiC

View carrier →

UnitedHealthcare of ColoradoDOI 6C-3

View carrier →

UnitedHealthcare InsuranceFederal TiC

View carrier →

Related Investigations

All providers in Anthem Blue Cross Blue Shield networkView →All Cardiac Surgery providers statewideView →All providers in AURORA 80045View →All providers classified as Needs ReviewView →

Known Addresses

NPPESAURORA, 80045

Evidence

12573 items across 16 assertions from 13 sources

Connected Records

Colorado License

Expired

DORA

Practice Address

AURORA, 80045

NPPES

Carrier Network Listing

Listed in 6 carrier networks

TiC: Anthem Blue Cross Blue Shield, TiC: UnitedHealthcare Services, TiC: UnitedHealthcare Insurance, TiC: UnitedHealthcare (UMR), TiC: UnitedHealthcare Colorado, TiC: UnitedHealthcare (Surest)

NPI Registration

Status: active

NPPES Deactivation

Open Payments

Record found

cms_open_payments

Order/Referring Eligibility

Record found

cms_order_refer

Medicare Enrollment

Enrolled

PECOS

Medicare Billing

86 services

cms_medicare

entity_type

Record found

NPPES

Federal Exclusion Check

No exclusion found

OIG LEIE + SAM.gov

Evidence Lineage

Carrier Network ListingTrust: 0.80

↓TiC: Anthem Blue Cross Blue Shield12531 records ·weight 0.80 · Latest: Mar 14, 2026

Carrier Network ListingTrust: 0.80

↓TiC: Anthem Blue Cross Blue Shieldweight 0.80 · Mar 13, 2026

Colorado License StatusTrust: 0.95

↓DORA3 records ·weight 0.95 · Latest: Mar 6, 2026

Matched via: primary

Carrier Network ListingTrust: 0.80

↓TiC: UnitedHealthcare Services5 records ·weight 0.80 · Latest: Mar 12, 2026

Carrier Network ListingTrust: 0.80

↓TiC: UnitedHealthcare Insurance

Timeline

Mar 14, 2026Carrier listing: Anthem Blue Cross Blue Shield

Mar 13, 2026DORA license check: Expired

Mar 12, 2026Carrier listing: UnitedHealthcare Services

Mar 12, 2026Carrier listing: UnitedHealthcare Insurance

Mar 12, 2026NPPES record: active

Mar 12, 2026Carrier listing: UnitedHealthcare (UMR)

Mar 12, 2026Carrier listing: UnitedHealthcare Colorado

Mar 11, 2026Carrier listing: UnitedHealthcare (Surest)

Mar 11, 2026Open Payments: record found

Mar 11, 2026Order/Referring Eligibility: record found

Mar 11, 2026

Evidence

Loading evidence lineage...

Disclaimer: This analysis uses publicly available federal and state data sources. It does not constitute a determination of provider status or network participation. Contact the provider or health plan directly to verify current status.

Evidence

12573 items across 16 assertions from 13 sources

Connected Records

Colorado License

Expired

DORA

Practice Address

AURORA, 80045

NPPES

Carrier Network Listing

Listed in 6 carrier networks

TiC: Anthem Blue Cross Blue Shield, TiC: UnitedHealthcare Services, TiC: UnitedHealthcare Insurance, TiC: UnitedHealthcare (UMR), TiC: UnitedHealthcare Colorado, TiC: UnitedHealthcare (Surest)

NPI Registration

Status: active

NPPES Deactivation

Open Payments

Record found

cms_open_payments

Order/Referring Eligibility

Record found

cms_order_refer

Medicare Enrollment

Enrolled

PECOS

Medicare Billing

86 services

cms_medicare

entity_type

Record found

NPPES

Federal Exclusion Check

No exclusion found

OIG LEIE + SAM.gov

Evidence Lineage

Carrier Network ListingTrust: 0.80

↓TiC: Anthem Blue Cross Blue Shield12531 records ·weight 0.80 · Latest: Mar 14, 2026

Carrier Network ListingTrust: 0.80

↓TiC: Anthem Blue Cross Blue Shieldweight 0.80 · Mar 13, 2026

Colorado License StatusTrust: 0.95

↓DORA3 records ·weight 0.95 · Latest: Mar 6, 2026

Matched via: primary

Carrier Network ListingTrust: 0.80

↓TiC: UnitedHealthcare Services5 records ·weight 0.80 · Latest: Mar 12, 2026

Carrier Network ListingTrust: 0.80

↓TiC: UnitedHealthcare Insurance

Timeline

Mar 14, 2026Carrier listing: Anthem Blue Cross Blue Shield

Mar 13, 2026DORA license check: Expired

Mar 12, 2026Carrier listing: UnitedHealthcare Services

Mar 12, 2026Carrier listing: UnitedHealthcare Insurance

Mar 12, 2026NPPES record: active

Mar 12, 2026Carrier listing: UnitedHealthcare (UMR)

Mar 12, 2026Carrier listing: UnitedHealthcare Colorado

Mar 11, 2026Carrier listing: UnitedHealthcare (Surest)

Mar 11, 2026Open Payments: record found

Mar 11, 2026Order/Referring Eligibility: record found

Mar 11, 2026