He was first to a start private, self financing medical college offering MBBS in India. Pai established the Kasturba Medical College, Manipal (KMC) in 1953 and Manipal Institute of Technology (MIT) in 1957, which was followed by a string of other education institutions including Kasturba Medical College, Mangalore, Manipal College of Dental Sciences, Manipal College of Pharmaceutical Sciences and T A Pai Management Institute (TAPMI). He also established Syndicate Bank, which has its headquarters in Manipal. He was responsible for its popular Pigmy Deposit Scheme.
The Government of India brought out a stamp commemorating Pai on October 9, 1999. Dr Pai has also been recognised by Ripley's Believe It or Not as the person who has established the most number of education institutions in his lifetime.
Dr. T.M.A. Pai has been succeeded by his son Dr Ramdas Pai, who has been instrumental in expanding the horizons of the Manipal Group. He is the present Chancellor of Manipal University, (formerly known as MAHE).
From one medical college in 1953, their educational empire has expanded to 24 professional colleges in 12 professional streams with 9 campuses and 2 universities. The Manipal Group has gone global with campuses in Nepal, Malaysia, Dubai, Muscat, Sri Lanka and Antigua. It has its presence in 20 countries.