Individual provider Active NPI

Sweta Shah, DDS

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1093070435
Registry record updated Jan 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
018001843 Issued in IL
Practice address
5425 W Lake St
Chicago, IL 60644-2342
Phone
(773) 378-3347
Fax
(773) 378-4028
NPI assigned
Jul 11, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 018001843 IL Primary

Addresses

Primary practice location

5425 W Lake St
Chicago, IL 60644-2342

Mailing address

2650 Ridge Ave
Evanston, IL 60201-1718
Phone (847) 570-2000

Other practice location 1

2650 Ridge Ave
Evanston, IL 60201-1718
Phone (847) 570-2000

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171024002435 IL Practitioner - DentistPractitioner - Oral Surgery 4587930235 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
018001843ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
PCC Community Wellness Center CurrentSince Jul 1, 2019 Accepting new patients
PCC Community Wellness Center CurrentSince Jul 1, 2019 Accepting new patients

Locations

6201 Roosevelt Rd
Berwyn, IL 60402
Phone (708) 386-0845

5425 W Lake St
Chicago, IL 60644
Phone (773) 378-3347

14 Lake St
Oak Park, IL 60302
Phone (708) 383-0113

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.

NPI Registry JSON

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

{
    "created_epoch": "1341964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577923200000",
    "number": "1093070435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5425 W LAKE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606442342",
            "telephone_number": "773-378-3347",
            "fax_number": "773-378-4028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2650 Ridge Ave",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602011718",
            "country_code": "US",
            "telephone_number": "847-570-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "SWETA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-11",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "018001843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.