Active NPI
Binni Kothari
- Physician Assistant
- Las Vegas, NV
National Provider Identifier
1104215250
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA1588
- Practice address
- 888 S Rancho Dr
Las Vegas, NV 89106-3810 - Phone
- (702) 877-8600
- Fax
- (702) 258-6152
- NPI assigned
- Jan 13, 2015
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA1588 | NV | Primary |
Addresses
Primary practice location
888 S Rancho Dr
Las Vegas, NV 89106-3810
Mailing address
PO Box 15645
Las Vegas, NV 89114-5645
Phone (702) 877-8600
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| V109885 | Other | NV | SMA MEDICARE |
| 1104215250 | Medicaid | NV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shadow Emergency Physicians PLLC | Physician Assistant | Current | Accepting new patients |
Locations
2075 E Flamingo Rd
Las Vegas, NV 89119
Phone (702) 369-7613
620 Shadow Ln
Las Vegas, NV 89106
Phone (702) 388-4506
Organizations & group practices 3
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.
-
- Emergency Medicine Physician
- Las Vegas, NV
- NPI 1184795874
-
- Internal Medicine Physician
- Las Vegas, NV
- NPI 1659346005
-
- Emergency Medicine Physician
- Las Vegas, NV
- NPI 1043030919
Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485129600000",
"number": "1104215250",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 15645",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891145645",
"telephone_number": "702-877-8600",
"fax_number": "702-258-6152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "888 S RANCHO DR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891063810",
"telephone_number": "702-877-8600",
"fax_number": "702-258-6152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOTHARI",
"first_name": "BINNI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-13",
"last_updated": "2017-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NV",
"license": "PA1588",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SMA MEDICARE",
"identifier": "V109885",
"state": "NV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1104215250",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2017; 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.