NPIMap

Individual provider Active NPI

Shobha Khandelwal, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Medina, OH
National Provider Identifier
1083609622
Registry record updated Nov 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
054767K Issued in OH
Practice address
970 E Washington St
Ste-2F
Medina, OH 44256-3332
Phone
(330) 723-7999
Fax
(330) 764-9907
NPI assigned
Sep 20, 2005
Last updated
Nov 17, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 054767K OH Primary

Addresses

Primary practice location

970 E Washington St
Ste-2F
Medina, OH 44256-3332

Mailing address

970 E Washington St
Ste 2F
Medina, OH 44256-2181
Phone (330) 722-8886

Other identifiers 1

IdentifierTypeStateIssuer
0788750MedicaidOH

Other names 1

  • Shobha Kumari Mohanka Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100226000207 OH Practitioner - Geriatric MedicinePractitioner - Internal Medicine 0143304063 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric MedicineAlso: Internal Medicine
Education
Other, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
A and S Khandelwal MD IncGroup PAC ID 1850358300, 6 clinicians

Practice addresses (Care Compare)

970 E Washington St
Suite 2F
Medina, OH 44256-2181
Phone (330) 723-7999

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
054767KOHMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
A & S Khandelwal MD Inc Geriatric Medicine CurrentSince Oct 1, 1988 Accepting new patients
Burbank Parke Care Center, Inc. Past Accepting new patients

Locations

970 E Washington St
Ste 2F
Medina, OH 44256
Phone (330) 723-7999

Interoperability endpoints

  • Direct secure messaging: skhandelwal@askhandelwal.medentdirect.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Burbank ParkeBurbank, OH, CCN 366392 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Sep 16, 2010
Sep 16, 2010
Champion Creek Health and RehabilitationMedina, OH, CCN 725008 Skilled nursing facility Adp of the SNF May 15, 2025

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510876800000",
    "number": "1083609622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "970 E WASHINGTON ST",
            "address_2": "STE 2F",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442562181",
            "telephone_number": "330-722-8886",
            "fax_number": "330-764-9907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 E WASHINGTON ST",
            "address_2": "STE-2F",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442563332",
            "telephone_number": "330-723-7999",
            "fax_number": "330-764-9907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHANDELWAL",
        "first_name": "SHOBHA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-20",
        "last_updated": "2017-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "OH",
            "license": "054767K",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0788750",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHOBHA",
            "last_name": "MOHANKA",
            "middle_name": "KUMARI",
            "credential": "M.B.B.S",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Medina, OH

Sources for this page

Verify at the official NPI Registry.