Shoba Menon, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2308051 Issued in NY

Practice address

1866 Wading River Manor Rd
Wading River, NY 11792-2137

Phone

(631) 929-8787

Fax

(631) 929-0350

NPI assigned

Dec 8, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 15

Other names 1

• Shoba Mulloth Former name

Medicare fee-for-service enrollment

Enrolled in NY

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

Internal Medicine

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

North Shore Hematology Oncology Associates PCGroup PAC ID 1456243641, 474 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Catholic Home Care Home health agency, Farmingdale, NY, CCN 337147
• Peconic Bay Homehealth Services Home health agency, Riverhead, NY, CCN 337400
• Centerwell Home Health Home health agency, Hauppauge, NY, CCN 337232
• Tender Loving Care, an Amedisys Company Home health agency, Medford, NY, CCN 337260
• Constellation Home Care Home health agency, Syosset, NY, CCN 337447
• John T Mather Memorial Hospital of Port Jefferson Hospital, Port Jefferson, NY, CCN 330185
• Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393
• Long Island Community Hospital Hospital, Patchogue, NY, CCN 330141

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

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.

• North Shore Hematology Oncology Associates PC

  • Specialist
  • Port Jefferson Station, NY
  • NPI 1396794574
  Medicare reassignment Care Compare group NPD

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

• QC-Medi New York, Inc.

  • Home Health Agency
  • Hauppauge, NY
  • NPI 1376575977
  Care Compare affiliation Name & address match
• Central Suffolk Hospital

  • Home Health Agency
  • Riverhead, NY
  • NPI 1932155678
  Care Compare affiliation
• Constellation Home Care LLC

  • Home Health Agency
  • Syosset, NY
  • NPI 1841629698
  Care Compare affiliation
• John T. Mather Memorial Hospital

  • General Acute Care Hospital
  • Port Jefferson, NY
  • NPI 1093718728
  Care Compare affiliation
• Nursing Sisters Home Care, Inc.

  • Home Health Agency
  • Farmingdale, NY
  • NPI 1780670711
  Care Compare affiliation
• NYU Langone Hospitals

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Patchogue, NY
  • NPI 1013724061

  Hospital

  Care Compare affiliation
• NYU Langone Hospitals

  • General Acute Care Hospital
  • Patchogue, NY
  • NPI 1831910355
  Care Compare affiliation
• Tender Loving Care Health Care Services of Nassau Suffolk, LLC

  • Home Health Agency
  • Medford, NY
  • NPI 1699715961
  Care Compare affiliation
• University Hospital at Stony Brook

  • General Acute Care Hospital
  • Southampton, NY
  • NPI 1033224704
  Care Compare affiliation
• University Hospital at Stony Brook

  • General Acute Care Hospital
  • Southampton, NY
  • NPI 1225507114
  Care Compare affiliation
• University Hospital at Stony Brook

  • Land Ambulance
  • Stony Brook, NY
  • NPI 1306620588

  Hospital

  Care Compare affiliation
• University Hospital at Stony Brook

  • General Acute Care Hospital
  • Greenport, NY
  • NPI 1881690691
  Care Compare affiliation

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311033600000",
    "number": "1154481539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1866 WADING RIVER MANOR RD",
            "address_2": "PO BOX 625",
            "city": "WADING RIVER",
            "state": "NY",
            "postal_code": "117922137",
            "telephone_number": "631-929-8787",
            "fax_number": "631-929-0350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1866 WADING RIVER MANOR RD",
            "city": "WADING RIVER",
            "state": "NY",
            "postal_code": "117922137",
            "telephone_number": "631-929-8787",
            "fax_number": "631-929-0350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENON",
        "first_name": "SHOBA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-08",
        "last_updated": "2011-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "2308051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5536793",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "9398762",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "2504648",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VYTRA",
            "identifier": "EP2144629",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ATLANTIS",
            "identifier": "MS0805",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIP",
            "identifier": "230805",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VYTRA",
            "identifier": "HB2144626",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VYTRA",
            "identifier": "RH2144630",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGNACARE",
            "identifier": "364487963",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEVON",
            "identifier": "364487963",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "136728",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMP GOVT",
            "identifier": "364487963",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "5607709",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IGA",
            "identifier": "364487963",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1199",
            "identifier": "NY230805",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHOBA",
            "last_name": "MULLOTH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elisa Matteson
• Lisa McConnell, RN
• Jillian McElwee, L.AC
• Sara Elizabeth McGuire, NP
• Peggy McLoughlin
• Tara Milcetic
• Katora Miller
• Roshanna Miller
• Taryn E Miller, LCSW
• Corinne Milmoe

• Internal Medicine Physician in Wading River, NY
• Providers in Wading River, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2011; 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.