Active NPI
Mamta D Shah, DO
- Pediatric Critical Care Medicine Physician
- Loma Linda, CA
National Provider Identifier
1083235006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Critical Care Medicine Physician
- License
- 20A21088
- Practice address
- 11234 Anderson St
Loma Linda, CA 92354-2804 - Phone
- (905) 558-4250
- NPI assigned
- Apr 30, 2020
- Last updated
- Jun 30, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Critical Care Medicine Physician | 2080P0203X | 20A21088 | CA | Primary |
Addresses
Primary practice location
11234 Anderson St
Loma Linda, CA 92354-2804
Mailing address
27431 San Bernardino Ave Apt 263
Redlands, CA 92374-5087
Phone (562) 584-3661
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200624002768 | AZ | Order and Referring Only - Pediatric Medicine | 8820410632 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A21088 | CA | MD | Pediatric Critical Care Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688083200000",
"number": "1083235006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27431 SAN BERNARDINO AVE APT 263",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923745087",
"telephone_number": "562-584-3661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11234 ANDERSON ST",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923542804",
"telephone_number": "905-558-4250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAH",
"first_name": "MAMTA",
"middle_name": "D",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-30",
"last_updated": "2023-06-30",
"certification_date": "2023-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "CA",
"license": "20A21088",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.