Individual provider Active NPI

Prashanth Shanmugham, M.D.

  • Pediatric Critical Care Medicine Physician
  • Pensacola, FL
National Provider Identifier
1003340142
Registry record updated Oct 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
ME145475 Issued in FL
Practice address
5151 N 9TH Ave
Pensacola, FL 32504-8721
Phone
(850) 416-4970
NPI assigned
Apr 15, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X ME145475 FL Primary

Addresses

Primary practice location

5151 N 9TH Ave
Pensacola, FL 32504-8721

Mailing address

4205 Belfort Rd Ste 4015
Jacksonville, FL 32216-3623
Phone (904) 450-6063

Other identifiers 1

IdentifierTypeStateIssuer
118231800MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pshanmugham344173@MHSDIRECT.NET

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230727002067 FL Practitioner - Pediatric MedicinePractitioner - Critical Care (Intensivists) 3072886662 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Sacred Heart Health System, Inc. CurrentSince Jun 13, 2024 Accepting new patients
Pediatric Critical Care of S FL PA Pediatric Critical Care Medicine CurrentSince Jul 1, 2023 Accepting new patients
Sacred Heart Health System Inc CurrentSince Jun 13, 2024 Accepting new patients
Sacred Heart Health System, Inc. Current Accepting new patients

Locations

1117 E Hallandale Beach Blvd
Hallandale Beach, FL 33009
Phone (954) 454-5131

1005 N 35th Ave
Hollywood, FL 33021
Phone (954) 265-5324

4205 Belfort Rd
Ste 4015
Jacksonville, FL 32216
Phone (904) 296-5691

3501 Johnson St
Pembroke Park, FL 33021
Phone (954) 265-2000

1657 Trinity Dr
Pensacola, FL 32504
Phone (850) 416-2400

5151 N 9th Ave
Pensacola, FL 32504
Phone (850) 202-4700

Interoperability endpoints

  • Direct secure messaging: pshanmugham344173@mhsdirect.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728000000000",
    "number": "1003340142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD STE 4015",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322163623",
            "telephone_number": "904-450-6063",
            "fax_number": "904-539-4091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5151 N 9TH AVE",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048721",
            "telephone_number": "850-416-4970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANMUGHAM",
        "first_name": "PRASHANTH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-15",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "FL",
            "license": "ME145475",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118231800",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pshanmugham344173@MHSDIRECT.NET",
            "affiliation": "N",
            "address_1": "1005 N 35th Ave",
            "city": "Hollywood",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330215402",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

Verify at the official NPI Registry.