Individual provider Active NPI

Shantanu Baghel, DO

  • Psychiatry Physician
  • Wilmington, NC
National Provider Identifier
1134610983
Registry record updated Jan 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
2024-03141 Issued in NC
Practice address
2131 S 17TH St
Wilmington, NC 28401-7407
Phone
(910) 667-7000
Fax
(910) 815-5850
NPI assigned
May 28, 2018
Last updated
Jan 9, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 305107 NY
Psychiatry Physician 2084P0800X 2024-03141 NC Primary

Addresses

Primary practice location

2131 S 17TH St
Wilmington, NC 28401-7407

Mailing address

PO Box 14890
Albany, NY 12212-4890

Other practice location 1

315 S Manning Blvd
Albany, NY 12208-1707
Phone (518) 525-1301

Other practice location 2

2215 Burdett Ave
Troy, NY 12180-2466
Phone (518) 833-6470

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address payer.credentialing@sphp.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230719001688 NY Practitioner - Psychiatry 5092058636 Reassigns benefits to 3 organizations
I20250311002204 NC Practitioner - Psychiatry 5092058636 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2131 S 17TH St
Wilmington, NC 28401-7407
Phone (910) 667-3000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
305107NYMDPsychiatry Physician
238755NCMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Samaritan Hospital of Troy, New York Psychiatry CurrentSince Jul 9, 2023 Accepting new patients
Ellis Hospital CurrentSince Aug 6, 2023 Accepting new patients
St. Peter's Hospital of the City of Albany Psychiatry CurrentSince Jul 9, 2023 Accepting new patients
St. Peter's Hospital of the City of Albany Psychiatry CurrentSince Jul 9, 2023 Accepting new patients
NMG Health Services LLC CurrentSince Dec 13, 2024 Accepting new patients
Novant Health Medical Group Coastal Region, LLC Current Accepting new patients
Novant Health Medical Group Coastal Region, LLC Psychiatry CurrentSince Dec 13, 2024 Accepting new patients
Baghel Psychiatry, PLLC Psychiatry Current Accepting new patients
Novant Health New Hanover Regional Medical Center LLC Past Accepting new patients

Locations

800 Jefferson St
Ste 112
Whiteville, NC 28472
Phone (910) 642-8164

2131 S 17th St
Wilmington, NC 28401
Phone (910) 342-3000

315 S Manning Blvd
Albany, NY 12208
Phone (518) 525-1852

845 Central Ave
Ste 107
Albany, NY 12206
Phone (518) 482-2455

1101 Nott St
Schenectady, NY 12308
Phone (518) 243-1916

433 State St
Fl 3
Schenectady, NY 12305

2215 Burdett Ave
Troy, NY 12180
Phone (518) 271-3300

Organizations & group practices 9

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 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": "1527465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736380800000",
    "number": "1134610983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14890",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122124890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2131 S 17TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017407",
            "telephone_number": "910-667-7000",
            "fax_number": "910-815-5850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "315 S Manning Blvd",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122081707",
            "country_code": "US",
            "telephone_number": "518-525-1301",
            "fax_number": "518-525-5691",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2215 Burdett Ave",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "NY",
            "postal_code": "121802466",
            "country_code": "US",
            "telephone_number": "518-833-6470",
            "fax_number": "518-271-3682",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAGHEL",
        "first_name": "SHANTANU",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-28",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "305107",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "2024-03141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP - Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2215 Burdett Ave",
            "city": "Troy",
            "state": "NY",
            "country_code": "US",
            "postal_code": "121802466",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.