Individual provider Active NPI

Nishant Shah, MD

  • Neurology with Special Qualifications in Child Neurology Physician
  • Park Ridge, IL
National Provider Identifier
1043254980
Registry record updated Dec 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
036-095353 Issued in IL
Practice address
1675 Dempster St
Park Ridge, IL 60068-1110
Phone
(847) 723-5962
Fax
(847) 723-2325
NPI assigned
Jun 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 036-095353 IL Primary

Addresses

Primary practice location

1675 Dempster St
Park Ridge, IL 60068-1110

Mailing address

3217 Brandess Dr
Glenview, IL 60026-1177
Phone (847) 723-5962

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address nshah206336@direct.myadvocateaurora.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20061121000367 IL Practitioner - NeurologyPractitioner - Pediatric Medicine 3072511377 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NeurologyAlso: Pediatric Medicine
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1875 Dempster St
Park Ridge, IL 60068-1130

214 McHenry Rd
Buffalo Grove, IL 60089-6748
Phone (847) 459-1160

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-095353ILMDNeurology with Special Qualifications in Child Neurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince Jul 19, 2010 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jul 19, 2010 Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

135 N Arlington Heights Rd
Buffalo Grove, IL 60089
Phone (847) 215-8866

29373 Network Pl
Chicago, IL 60673

1675 W Dempster St
Fl 3
Park Ridge, IL 60068
Phone (847) 318-9330

1675 W Dempster St
Park Ridge, IL 60068
Phone (847) 318-9300

Organizations & group practices 2

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 6

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": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1043254980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3217 BRANDESS DR",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600261177",
            "telephone_number": "847-723-5962",
            "fax_number": "847-723-2325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 DEMPSTER ST",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681110",
            "telephone_number": "847-723-5962",
            "fax_number": "847-723-2325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "NISHANT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "IL",
            "license": "036-095353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1675 Dempster St",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600681110",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nshah206336@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1675 Dempster St",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600681110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

Verify at the official NPI Registry.