Individual provider Active NPI

Samir Shah, DO

  • Internal Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1104563790
Registry record updated Aug 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS21482 Issued in FL
Practice address
3625 University Blvd S
Jacksonville, FL 32216-4207
Phone
(904) 702-6111
NPI assigned
May 16, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS21482 FL Primary

Addresses

Primary practice location

3625 University Blvd S
Jacksonville, FL 32216-4207

Mailing address

3625 University Blvd S
Jacksonville, FL 32216-4207
Phone (904) 702-6111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20250910003658 FL Practitioner - Internal Medicine 4587167184 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Inpatient Consultants of Florida, IncGroup PAC ID 4789614785, 158 clinicians
Refined Medical Group LLCGroup PAC ID 9335621218, 3 clinicians

Practice addresses (Care Compare)

12645 Salina Dr
Jacksonville, FL 32246-2291
Phone (904) 787-8150

15255 Max Leggett Pkwy
Jacksonville, FL 32218-7273
Phone (904) 281-0944

Hospital & facility affiliations

  • HCA Florida Memorial Hospital Hospital, Jacksonville, FL, CCN 100179

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Inpatient Consultants of Florida Inc Internal Medicine CurrentSince Aug 1, 2025 Accepting new patients
Inpatient Consultants of Florida, Inc Internal Medicine Current Accepting new patients
Florida Rehab Specialists, PLLC Internal Medicine CurrentSince Dec 16, 2025 Accepting new patients
Inpatient Consultants of Florida, Inc Internal Medicine CurrentSince Aug 1, 2025 Accepting new patients
Refined Medical Group LLC CurrentSince Feb 16, 2026 Accepting new patients
Memorial Healthcare Group Inc Past Accepting new patients

Locations

1130 NW 15th St
Boca Raton, FL 33486
Phone (561) 394-6282

817 NW 56th Ter
Ste B
Gainesville, FL 32605
Phone (352) 331-7771

3625 University Blvd S
Jacksonville, FL 32216
Phone (904) 333-9404

15255 Max Leggett Pkwy
Jacksonville, FL 32218
Phone (904) 383-1000

12645 Salina Dr
Jacksonville, FL 32246
Phone (904) 787-8150

2001 W 68th St
Miami Lakes, FL 33016
Phone (305) 364-2151

350 7th St N
Naples, FL 34102
Phone (239) 436-5000

2800 SW 41st St
Ocala, FL 34474
Phone (352) 291-4600

3030 W Bearss Ave
Tampa, FL 33618
Phone (813) 932-2222

300 NW 1st Ave
Williston, FL 32696
Phone (352) 528-3561

Interoperability endpoints

  • Direct secure messaging: sshah26651@direct.xtensys.com

Organizations & group practices 6

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.

Hospital & facility affiliations 1

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": "1652659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787875200000",
    "number": "1104563790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3625 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164207",
            "telephone_number": "904-702-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3625 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164207",
            "telephone_number": "904-702-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "SAMIR",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-16",
        "last_updated": "2026-08-28",
        "certification_date": "2026-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS21482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.