Rushabh Anilkumar Shah, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

01072555A Issued in IN

Practice address

1919 Lake Ave
Suite 110
Plymouth, IN 46563-7830

Phone

(574) 948-5290

Fax

(574) 948-5495

NPI assigned

Jun 2, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: rshah1154611@direct.trinity-health.org

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.

• Saint Joseph Regional Medical Center, Inc.

  • Family Medicine Physician
  • Mishawaka, IN
  • NPI 1467406074

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1275436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700092800000",
    "number": "1033439989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 CEDAR ST STE 405",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 LAKE AVE",
            "address_2": "SUITE 110",
            "city": "PLYMOUTH",
            "state": "IN",
            "postal_code": "465637830",
            "telephone_number": "574-948-5290",
            "fax_number": "574-948-5495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "RUSHABH",
        "middle_name": "ANILKUMAR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-02",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301096224",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01072555A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201166310",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rushabh.shah@directsjpn.mhin.net",
            "affiliation": "N",
            "endpointDescription": "St Joseph reg med center direct email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "ccd",
            "address_1": "1919 Lake Ave",
            "address_2": "Suite 110",
            "city": "Plymouth",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465637830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Misty Dawn Sellers, RN
• Anne Setnor, DACM
• Marilla Shafer
• Pamela A Shafer, M.A.
• Dinesh C Shah, MD
• Shoptikal LLC
• Anand Singla, MBBS
• Heather A Skelly, ATC,L
• Allasyn Slater
• Dakotah Smith-Shepherd

• Pediatrics Physician in Plymouth, IN
• Providers in Plymouth, IN by specialty
• Pediatrics Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.