NPIMap

Organization Active NPI

Nilam D Shah PA

  • Primary Care Clinic/Center
  • Saint Petersburg, FL
National Provider Identifier
1194177857
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
NILAM D SHAH PA
Practice address
5778 5TH Ave N
Saint Petersburg, FL 33710-7104
Phone
(727) 388-2625
Fax
(727) 828-9233
NPI assigned
Jul 6, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

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

Authorized official

Name
Dr. Nilamben D Shah, MDNPI 1356306070
Title
President
Phone
(727) 417-0233

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

5778 5TH Ave N
Saint Petersburg, FL 33710-7104

Mailing address

5778 5TH Ave N
Saint Petersburg, FL 33710-7104
Phone (727) 388-2625

Other identifiers 1

IdentifierTypeStateIssuer
020378900MedicaidFL

Other names 1

  • Sunrise Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170208000578 FL Part B Supplier - Clinic/Group Practice 5395028864 Receives reassigned benefits from 3 practitioners
Practice locations: St Petersburg, FL

National Provider Directory

National Provider Directory

Locations

5750 5th Ave N
St Petersburg, FL 33710
Phone (727) 388-2625

Practitioners & affiliated clinicians

Practitioners 5

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": "1467763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706572800000",
    "number": "1194177857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5778 5TH AVE N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337107104",
            "telephone_number": "727-388-2625",
            "fax_number": "727-828-9233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5778 5TH AVE N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337107104",
            "telephone_number": "727-388-2625",
            "fax_number": "727-828-9233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NILAM D SHAH PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-06",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "NILAMBEN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "727-417-0233",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020378900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunrise Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sunrise Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; 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.