Active NPI
Shyam Jayant Deshpande, M.D.
- Pediatric Critical Care Medicine Physician
- Philadelphia, PA
National Provider Identifier
1013301316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Critical Care Medicine Physician
- License
- MD478006
- Practice address
- 3401 Civic Center Blvd
Philadelphia, PA 19104-4319 - Phone
- (267) 426-2958
- NPI assigned
- Mar 24, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 274306 | MA | |
| Pediatrics Physician | 208000000X | 60950335 | WA | |
| Pediatric Critical Care Medicine Physician | 2080P0203X | MD478006 | PA | Primary |
Addresses
Primary practice location
3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Mailing address
3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 274306 | MA | MD | Pediatrics Physician |
| 60950335 | WA | MD | Pediatrics Physician |
| MD478006 | PA | MD | Pediatric Critical Care Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656892800000",
"number": "1013301316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3401 CIVIC CENTER BLVD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 CIVIC CENTER BLVD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044319",
"telephone_number": "267-426-2958"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESHPANDE",
"first_name": "SHYAM",
"middle_name": "JAYANT",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-03-24",
"last_updated": "2022-07-04",
"certification_date": "2022-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MA",
"license": "274306",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WA",
"license": "60950335",
"primary": false
},
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "PA",
"license": "MD478006",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.