Individual provider Active NPI

Shilpa Mohan Ullikashi, MD

  • Pediatrics Physician
  • Casa Grande, AZ
National Provider Identifier
1033632336
Registry record updated Aug 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
73510 Issued in AZ
Practice address
1760 E Florence Blvd Ste 100
Casa Grande, AZ 85122-4765
Phone
(520) 374-6505
NPI assigned
Jul 19, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 70172-20 WI
Student in an Organized Health Care Education/Training Program 390200000X WI
Pediatrics Physician 208000000X 73510 AZ Primary

Addresses

Primary practice location

1760 E Florence Blvd Ste 100
Casa Grande, AZ 85122-4765

Mailing address

1760 E Florence Blvd Ste 100
Casa Grande, AZ 85122-4765
Phone (520) 374-6505

Other practice location 1

1715 Dousman St
Green Bay, WI 54303-3211
Phone (920) 496-4700

Other practice location 2

1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, AZ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200902002541 WI Practitioner - Pediatric Medicine 4587909353
I20240806001490 AZ Practitioner - Pediatric Medicine 4587909353 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
73510AZMDPediatrics Physician
70172-20WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Childrens Banner Health Clinic LLC CurrentSince Aug 26, 2024 Accepting new patients
Banner Childrens Banner Health Clinic LLC CurrentSince Aug 26, 2024 Accepting new patients
Banner Childrens Banner Health Clinic LLC Current Accepting new patients

Locations

1760 E Florence Blvd
Ste 100
Casa Grande, AZ 85122
Phone (520) 374-6505

Organizations & group practices 3

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": "1500422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723161600000",
    "number": "1033632336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1760 E FLORENCE BLVD STE 100",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851224765",
            "telephone_number": "520-374-6505",
            "fax_number": "520-374-6501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1760 E FLORENCE BLVD STE 100",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851224765",
            "telephone_number": "520-374-6505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1715 Dousman St",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543033211",
            "country_code": "US",
            "telephone_number": "920-496-4700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 N Oak Ave",
            "address_purpose": "LOCATION",
            "city": "Marshfield",
            "state": "WI",
            "postal_code": "54449",
            "country_code": "US",
            "telephone_number": "715-387-5600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ULLIKASHI",
        "first_name": "SHILPA",
        "middle_name": "MOHAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-19",
        "last_updated": "2024-08-09",
        "certification_date": "2024-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "70172-20",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "73510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Casa Grande, AZ

Sources for this page

Verify at the official NPI Registry.