Individual provider Active NPI

Prakash D Shah, M.D.

  • Cardiovascular Disease Physician
  • Milwaukee, WI
National Provider Identifier
1013917996
Registry record updated Nov 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
32376 Issued in WI
Practice address
2801 W Kinnickinnic River Pkwy
Ste 840
Milwaukee, WI 53215-3669
Phone
(414) 649-3530
NPI assigned
Jul 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Cardiology Physician 207UN0901X 32376-020 WI
Cardiovascular Disease Physician 207RC0000X 32376 WI Primary

Addresses

Primary practice location

2801 W Kinnickinnic River Pkwy
Ste 840
Milwaukee, WI 53215-3669

Mailing address

2801 W Kinnickinnic River Pkwy
Ste 840
Milwaukee, WI 53215-3669
Phone (414) 649-3530

Other identifiers 1

IdentifierTypeStateIssuer
32171700MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address pshah20729@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20040318001000 WI Practitioner - Cardiovascular Disease (Cardiology) 7315859600 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Medical College of Wisconsin, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

2801 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3669
Phone (414) 385-8600

Hospital & facility affiliations

  • Aurora Medical Center Kenosha Hospital, Kenosha, WI, CCN 520189
  • Aurora St Lukes Medical Center Hospital, Milwaukee, WI, CCN 520138
  • Froedtert South Inc. Hospital, Kenosha, WI, CCN 520021
  • Aurora Memorial Hospital Burlington Hospital, Burlington, WI, CCN 520059
  • Advocate Condell Medical Center Hospital, Libertyville, IL, CCN 140202

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
32376WIMDCardiovascular Disease Physician
32376-020WIMDNuclear Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Dec 1, 2006 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Dec 1, 2006 Accepting new patients
Cardiovascular Associates of Wisconsin, LLP Cardiovascular Disease Past Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations (25 of 26)

1905 E Huebbe Pkwy
Beloit, WI 53511
Phone (608) 364-2293

W3985 Highway NN
Elkhorn, WI 53121
Phone (262) 741-2000

12500 W Bluemound Rd
Elm Grove, WI 53122
Phone (262) 780-3434

210 Wisconsin American Dr
Fond du Lac, WI 54937
Phone (920) 907-7000

2733 S Ridge Rd
Green Bay, WI 54304
Phone (920) 497-6200

123 N Military Ave
Green Bay, WI 54303
Phone (920) 494-3421

2845 Greenbrier Rd
#1
Green Bay, WI 54311
Phone (920) 288-8100

10117 74th St
Ste 110
Kenosha, WI 53142
Phone (262) 697-1919

6308 8th Ave
Kenosha, WI 53143
Phone (262) 653-5300

10400 75th St
Kenosha, WI 53142
Phone (262) 697-7000

1900 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

601 Reed Ave
Manitowoc, WI 54220
Phone (920) 682-8841

5017 S 110th St
Milwaukee, WI 53228
Phone (414) 427-8282

2801 W Kinnickinnic River Pkwy
Ste 840
Milwaukee, WI 53215
Phone (414) 649-3626

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

2801 W Kinnickinnic River Pkwy
Milwaukee, WI 53215
Phone (414) 384-5111

2801 W Kinnickinnic River Pkwy
#840
Milwaukee, WI 53215

1218 W Kilbourn Ave
Milwaukee, WI 53233
Phone (414) 219-7343

13250 Washington Ave
Mount Pleasant, WI 53177
Phone (262) 799-8330

8400 Washington Ave
Mount Pleasant, WI 53406
Phone (262) 231-3000

620 15th Ave
Union Grove, WI 53182
Phone (262) 878-1211

125 Hospital Dr
Fl 1
Watertown, WI 53098
Phone (920) 262-4449

125 Hospital Dr
Watertown, WI 53098
Phone (920) 261-4210

W231N1440 Corporate Ct
Waukesha, WI 53186
Phone (262) 896-6000

7220 W National Ave
West Allis, WI 53214
Phone (414) 257-8500

Networks

  • devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806

Interoperability endpoints

  • Direct secure messaging: pshah20729@direct.myadvocateaurora.org

Organizations & group practices 5

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637539200000",
    "number": "1013917996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 W KINNICKINNIC RIVER PKWY",
            "address_2": "STE 840",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153669",
            "telephone_number": "414-649-3530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 W KINNICKINNIC RIVER PKWY",
            "address_2": "STE 840",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153669",
            "telephone_number": "414-649-3530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "PRAKASH",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-21",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207UN0901X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": "WI",
            "license": "32376-020",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WI",
            "license": "32376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32171700",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pshah20729@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2801 W Kinnickinnic River Pkwy",
            "address_2": "Ste 840",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153669",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2801 W Kinnickinnic River Pkwy",
            "address_2": "Ste 840",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532153669",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.