Individual provider Active NPI

Shaida Nasiri-Blomgren, M.D.

  • Pediatric Gastroenterology Physician
  • Wilmington, DE
National Provider Identifier
1104266931
Registry record updated Apr 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
C1-0012673 Issued in DE
Practice address
1600 Rockland Rd
Wilmington, DE 19803-3607
Phone
(302) 651-5928
NPI assigned
Jun 25, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2020

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X C1-0012673 DE Primary
Pediatric Emergency Medicine (Emergency Medicine) Physician 207PP0204X C1-0012673 DE
Pediatrics Physician 208000000X A140317 CA
Pediatrics Physician 208000000X C1-0012673 DE
Pediatric Gastroenterology Physician 2080P0206X MD468912 PA

Addresses

Primary practice location

1600 Rockland Rd
Wilmington, DE 19803-3607

Mailing address

1600 Rockland Rd
Wilmington, DE 19803-3607
Phone (302) 651-5928

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181128002221 DE Practitioner - Emergency MedicinePractitioner - Pediatric Medicine 5193069375 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Pediatric Medicine
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Nemours FoundationGroup PAC ID 9537072483, 249 clinicians

Practice addresses (Care Compare)

1600 Rockland Rd
Wilmington, DE 19803-3607
Phone (302) 651-4200

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A140317CAMDPediatrics Physician
MD468912PAMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Nemours Foundation CurrentSince Oct 7, 2018 Accepting new patients
The Nemours Foundation CurrentSince Oct 7, 2018 Accepting new patients
The Nemours Foundation Past Accepting new patients

Locations

1600 Rockland Rd
Wilmington, DE 19803

2932 Springfield Rd
Broomall, PA 19008
Phone (610) 557-4800

101 Applied Bank Blvd
Ste 11
Glen Mills, PA 19342
Phone (484) 800-8630

Interoperability endpoints

  • Direct secure messaging: snasiri63488@direct.nemours.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1372118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587254400000",
    "number": "1104266931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 ROCKLAND RD",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198033607",
            "telephone_number": "302-651-5928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 ROCKLAND RD",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198033607",
            "telephone_number": "302-651-5928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NASIRI-BLOMGREN",
        "first_name": "SHAIDA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-25",
        "last_updated": "2020-04-19",
        "certification_date": "2020-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "DE",
            "license": "C1-0012673",
            "primary": true
        },
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "DE",
            "license": "C1-0012673",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A140317",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "DE",
            "license": "C1-0012673",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "PA",
            "license": "MD468912",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, DE

Sources for this page

Verify at the official NPI Registry.