Shivam Shah

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

License

MD472121 Issued in PA

Practice address

255 W Lancaster Ave
Paoli, PA 19301-1763

Phone

(484) 565-1596

Fax

(610) 889-0813

NPI assigned

Apr 17, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in PA

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

Specialty

Interventional RadiologyAlso: Diagnostic Radiology

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Radiology Associates of the Main Line P CGroup PAC ID 9931097193, 80 clinicians

Main Line Health Imaging LPGroup PAC ID 7618867664, 51 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Riddle Memorial Hospital Hospital, Media, PA, CCN 390222
• Main Line Hospital Lankenau Hospital, Wynnewood, PA, CCN 390195
• Paoli Hospital Hospital, Paoli, PA, CCN 390153
• Bryn Mawr Hospital Hospital, Bryn Mawr, PA, CCN 390139
• Hospital of Univ of Pennsylvania Hospital, Philadelphia, PA, CCN 390111

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Main Line Health Imaging LP

  • Diagnostic Radiology Physician
  • Wynnewood, PA
  • NPI 1477504264
  Medicare reassignment Care Compare group NPD
• Radiology Associates of the Main Line P C

  • Diagnostic Radiology Physician
  • Paoli, PA
  • NPI 1750332003
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Hospital of the University of PA

  • Ambulatory Fertility Facility
  • Phila, PA
  • NPI 1033262316

  Hospital

  Care Compare affiliation
• Main Line Hospitals, Inc.

  • General Acute Care Hospital
  • Paoli, PA
  • NPI 1215042114
  Care Compare affiliation
• Main Line Hospitals, Inc.

  • General Acute Care Hospital
  • Wynnewood, PA
  • NPI 1245335629
  Care Compare affiliation
• Main Line Hospitals, Inc.

  • General Acute Care Hospital
  • Bryn Mawr, PA
  • NPI 1508971441
  Care Compare affiliation
• Riddle Memorial Hospital

  • General Acute Care Hospital
  • Media, PA
  • NPI 1407856099
  Care Compare affiliation
• Trustees of the University of Pennsylvania

  • General Acute Care Hospital
  • Philadelphia, PA
  • NPI 1851370910
  Care Compare affiliation

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

{
    "created_epoch": "1397692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601510400000",
    "number": "1144640061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 678678",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752678678",
            "telephone_number": "800-475-6112",
            "fax_number": "423-826-1286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 W LANCASTER AVE",
            "city": "PAOLI",
            "state": "PA",
            "postal_code": "193011763",
            "telephone_number": "484-565-1596",
            "fax_number": "610-889-0813"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1249 White Dr",
            "address_purpose": "LOCATION",
            "city": "North Brunswick",
            "state": "NJ",
            "postal_code": "089021785",
            "country_code": "US",
            "telephone_number": "773-860-1318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "SHIVAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-17",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "MD472121",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "PA",
            "license": "MD472121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1D6800",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1D6795",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annette M Sexton, CRNP
• Maziar Seyedian, M. D.
• Keeley Seymour, LCSW
• Cari Shabot, LPC
• Mehul Shah, DMD
• Deborah Shank, MSN
• Susan Shannon, MA
• Dennis A Sharkey III, D.M.D.
• Lewis S Sharps, M.D.
• Erica Shaw, CRNP

• Vascular & Interventional Radiology Physician in Paoli, PA
• Providers in Paoli, PA by specialty
• Vascular & Interventional Radiology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.