NPIMap

Individual provider Active NPI

Pratish Ajay Shah, MD

  • Neuroradiology Physician
  • Springfield, IL
National Provider Identifier
1104142512
Registry record updated Apr 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuroradiology PhysicianTaxonomy code 2085N0700X
License
036137694 Issued in IL
Practice address
1025 S 6TH St
Springfield, IL 62703-2499
Phone
(217) 528-7541
NPI assigned
Apr 9, 2010
Last updated
Apr 22, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology Physician 2085N0700X 036137694 IL Primary
Neuroradiology Physician 2085N0700X 2020-02657 NC
Diagnostic Radiology Physician 2085R0202X 2020-02657 NC

Addresses

Primary practice location

1025 S 6TH St
Springfield, IL 62703-2499

Mailing address

PO Box 19248
Springfield, IL 62794-9248
Phone (217) 528-7541

Other practice location 1

3186 Village Dr Ste 201
Fayetteville, NC 28304-3979
Phone (910) 486-5700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, IL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200610002889 NC Practitioner - Diagnostic Radiology 1456630144 Reassigns benefits to 3 organizations
I20220315002416 IL Practitioner - Diagnostic Radiology 1456630144 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Springfield Clinic, LLPGroup PAC ID 0547166076, 678 clinicians

Practice addresses (Care Compare)

101 E Plummer Blvd
Chatham, IL 62629-8047
Phone (217) 483-3487

1600 W Walnut St
Jacksonville, IL 62650-1136
Phone (217) 245-9541

200 Stahlhut Dr 1St Floor Room
Suite 428
Lincoln, IL 62656-5066
Phone (217) 605-5309

565 White Oak Pond Rd
Apex, NC 27523-8035
Phone (217) 528-7541

701 N 1St St
Springfield, IL 62781-0001
Phone (217) 528-7541

775 Engineering Ave
Springfield, IL 62703-5909
Phone (217) 522-4300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2020-02657NCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Radiology P a Diagnostic Radiology CurrentSince Jul 1, 2020 Accepting new patients
Medical Imaging Center, LLC CurrentSince Jul 1, 2020 Accepting new patients
Bladen Healthcare LLC CurrentSince Jul 1, 2020 Accepting new patients
Springfield Clinic, LLP CurrentSince Mar 14, 2022 Accepting new patients
Bladen Healthcare LLC CurrentSince Jul 1, 2020 Accepting new patients

Locations

1025 S 6th St
Springfield, IL 62703

775 Engineering Ave
Springfield, IL 62703
Phone (217) 522-4300

501 S Poplar St
Elizabethtown, NC 28337
Phone (910) 862-4043

3186 Village Dr
Ste 201
Fayetteville, NC 28304
Phone 9104865700104

Interoperability endpoints

  • Direct secure messaging: pratish.shah.1@28977.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Springfield Clinic Lincoln Rural HealthLincoln, IL, CCN 143925 Rural health clinic Limited Partnership Interest Apr 1, 2024
Springfield Clinic Nokomis Rural HealthNokomis, IL, CCN 783814 Rural health clinic Limited Partnership Interest Apr 1, 2024
Springfield Clinic Raymond Rural HealthRaymond, IL, CCN 783829 Rural health clinic Limited Partnership Interest Jul 1, 2023
Springfield Clinic Neoga Rural HealthNeoga, IL, CCN 783812 Rural health clinic Limited Partnership Interest Apr 1, 2024
Springfield Clinic, LLPMacomb, IL, CCN 783855 Rural health clinic Limited Partnership Interest Apr 1, 2024

Owned or controlled facilities with NPI records 5

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

Organizations & group practices 5

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 5

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": "1270771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776816000000",
    "number": "1104142512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19248",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949248",
            "telephone_number": "217-528-7541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 S 6TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627032499",
            "telephone_number": "217-528-7541"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3186 Village Dr Ste 201",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283043979",
            "country_code": "US",
            "telephone_number": "910-486-5700",
            "fax_number": "910-486-5950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "PRATISH",
        "middle_name": "AJAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-09",
        "last_updated": "2026-04-22",
        "certification_date": "2026-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "IL",
            "license": "036137694",
            "primary": true
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "NC",
            "license": "2020-02657",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2020-02657",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.