Individual provider Active NPI

Pratik P Shah, MD

  • Emergency Medicine Physician
  • Chicago, IL
National Provider Identifier
1043451537
Registry record updated Mar 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
125051428 Issued in IL
Practice address
7435 W Talcott Ave
Resurrection Emergency Medicine Residency Program
Chicago, IL 60631-3707
Phone
(773) 792-7921
NPI assigned
Mar 13, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 125051428 IL Primary

Addresses

Primary practice location

7435 W Talcott Ave
Resurrection Emergency Medicine Residency Program
Chicago, IL 60631-3707

Mailing address

7435 W Talcott Ave
Resurrection Emergency Medicine Residency Program
Chicago, IL 60631-3707

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, IL2 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
I20110301000328 IN Practitioner - Emergency Medicine 4880875541 Reassigns benefits to 1 organization
I20120822000705 IL Practitioner - Emergency Medicine 4880875541 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Indiana University School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Medical Associates of Palos, LTD.Group PAC ID 1052578366, 20 clinicians

Practice addresses (Care Compare)

12251 S 80TH Ave
Palos Heights, IL 60463-1290
Phone (708) 923-5800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125051428ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medical Associates of Palos, LTD. Emergency Medicine CurrentSince Feb 1, 2022 Accepting new patients
Community Care Network Inc CurrentSince Jun 25, 2015 Accepting new patients

Locations

12251 S 80th Ave
Palos Heights, IL 60463
Phone (708) 361-4500

4321 Fir St
East Chicago, IN 46312
Phone (219) 392-1700

1500 S Lake Park Ave
Hobart, IN 46342
Phone (219) 942-0551

901 MacArthur Blvd
Munster, IN 46321
Phone (219) 703-1443

9130 Columbia Ave
Ste A
Munster, IN 46321
Phone (219) 365-1166

9660 Wicker Ave
Fl 2
Saint John, IN 46373
Phone (219) 226-2380

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 2

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": "1236902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236902400000",
    "number": "1043451537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7435 W TALCOTT AVE",
            "address_2": "RESURRECTION EMERGENCY MEDICINE RESIDENCY PROGRAM",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606313707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7435 W TALCOTT AVE",
            "address_2": "RESURRECTION EMERGENCY MEDICINE RESIDENCY PROGRAM",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606313707",
            "telephone_number": "773-792-7921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "PRATIK",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-13",
        "last_updated": "2009-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "125051428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.