NPIMap

Organization Active NPI

Shyam Verma MD PA

  • Nephrology Physician
  • Titusville, FL
National Provider Identifier
1104842913
Registry record updated Jun 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
ME0054560 Issued in FL
Legal business name
SHYAM VERMA MD PA
Practice address
801 Garden St
Titusville, FL 32796
Phone
(321) 267-1164
Fax
(321) 267-8378
NPI assigned
Jul 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2022

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

Authorized official

Name
Dr. Shyam Verma, M.D.NPI 1538358429
Title
Medical Director
Phone
(321) 267-1164

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X ME0054560 FL Primary

Addresses

Primary practice location

801 Garden St
Titusville, FL 32796

Mailing address

801 Garden St
Titusville, FL 32796-3408
Phone (321) 267-1164

Other identifiers 1

IdentifierTypeStateIssuer
049633200MedicaidFL

Other names 1

  • FLORIDA NEPHROLOGY ASSOCIATES Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120620000186 FL Part B Supplier - Clinic/Group Practice 3476717653 Receives reassigned benefits from 2 practitioners
Practice locations: Titusville, FL

National Provider Directory

National Provider Directory

Locations

801 Garden St
Unit A
Titusville, FL 32796

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654214400000",
    "number": "1104842913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 GARDEN ST",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327963408",
            "telephone_number": "321-267-1164",
            "fax_number": "321-267-8378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 GARDEN ST",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "32796",
            "telephone_number": "321-267-1164",
            "fax_number": "321-267-8378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHYAM VERMA MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-03",
        "status": "A",
        "authorized_official_last_name": "VERMA",
        "authorized_official_first_name": "SHYAM",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "321-267-1164",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME0054560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "049633200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FLORIDA NEPHROLOGY ASSOCIATES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Titusville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.