He was the first to start a private, self-financing medical college offering MBBS in India. Pai established the Kasturba Medical College in 1953 and Manipal Institute of Technology in 1957, which was followed by a string of other education institutions including Manipal College of Dental Sciences, Manipal College of Pharmaceutical Sciences and Manipal Pre-University College. He, along with his brother Upendra Ananth Pai, also established Syndicate Bank originally in Udupi, Karnataka, which has its headquarters now in Manipal and Bangalore. He was responsible for its popular Pigmy Deposit Scheme.
The Government of India brought out a stamp commemorating Pai on 9 October 1999. Pai has also been recognized by Ripley's Believe It or Not as the person who has established the most number of educational institutions in his lifetime.
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