Active NPI
Shailesh J. Shah, MD
- Pediatrics Physician
- Dracut, MA
National Provider Identifier
1144229584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 58096
- Practice address
- 1385 Lakeview Ave
Dracut, MA 01826-3414 - Phone
- (978) 957-6675
- Fax
- (978) 957-5887
- NPI assigned
- Jul 19, 2005
- Reactivated
- Mar 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 58096 | MA | Primary |
Addresses
Primary practice location
1385 Lakeview Ave
Dracut, MA 01826-3414
Mailing address
1385 Lakeview Ave
Dracut, MA 01826-3414
Phone (978) 957-6675
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 058096 | Other | MA | TUFTS HEALTH PLAN |
| 981952 | Other | MA | NETWORK HEALTH |
| 20432 | Other | MA | HARVARD PILGRIM |
| 3024491 | Medicaid | MA | |
| B11056101 | Other | MA | CIGNA |
| J06526 | Other | MA | BLUE CROSS BLUE SHIELD MA |
| 11258 | Other | MA | FALLON |
| 4041104 | Other | MA | AETNA |
| 12-01159 | Other | MA | UNITED HEALTHCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58096 | MA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311206400000",
"number": "1144229584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1385 LAKEVIEW AVE",
"city": "DRACUT",
"state": "MA",
"postal_code": "018263414",
"telephone_number": "978-957-6675",
"fax_number": "978-957-5887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1385 LAKEVIEW AVE",
"city": "DRACUT",
"state": "MA",
"postal_code": "018263414",
"telephone_number": "978-957-6675",
"fax_number": "978-957-5887"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAH",
"first_name": "SHAILESH",
"middle_name": "J.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-19",
"last_updated": "2011-07-21",
"deactivation_date": "2006-03-20",
"reactivation_date": "2006-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MA",
"license": "58096",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "058096",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NETWORK HEALTH",
"identifier": "981952",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "20432",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3024491",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "B11056101",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD MA",
"identifier": "J06526",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FALLON",
"identifier": "11258",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4041104",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "12-01159",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dracut, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.