NPIMap

Individual provider Active NPI

Mohamed Ihtesham Shaji, MD

  • Adolescent Medicine (Internal Medicine) Physician
  • Chicago, IL
National Provider Identifier
1194248914
Registry record updated Aug 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0000X
License
125.069826 Issued in IL
Practice address
4646 N Marine Dr
Chicago, IL 60640-5759
Phone
(773) 564-7400
NPI assigned
Jul 24, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent Medicine (Internal Medicine) Physician 207RA0000X 125.069826 IL Primary

Addresses

Primary practice location

4646 N Marine Dr
Chicago, IL 60640-5759

Mailing address

Dept of Gme, 4646 N Marine Dr
7TH FL Ste 7100
Chicago, IL 60640-5759

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200528000875 WI Practitioner - Internal Medicine 1557633203 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ascension Medical Group-Southeast Wisconsin IncGroup PAC ID 8628980943, 551 clinicians
Columbia St Marys Hospital Milwaukee IncGroup PAC ID 5890604722, 311 clinicians
Ascension Calumet Hospital IncGroup PAC ID 7416948427, 13 clinicians

Practice addresses (Care Compare)

10101 S 27TH St
Franklin, WI 53132-7209
Phone (414) 325-4700

13111 N Port Washington Rd
Mequon, WI 53097-2416
Phone (262) 243-7300

13125 N Port Washington Rd
Mequon, WI 53097-2416
Phone (262) 243-7408

13950 W Capitol Dr
Brookfield, WI 53005-2441
Phone (414) 302-5400

201 N Mayfair Rd
Wauwatosa, WI 53226-4216

2301 N Lake Dr
Milwaukee, WI 53211-4508

2323 N Lake Dr
Milwaukee, WI 53211-4508
Phone (414) 585-1000

5000 W Chambers St
Milwaukee, WI 53210-1650
Phone (414) 447-2569

614 Memorial Dr
Chilton, WI 53014-1568
Phone (800) 458-4042

801 S 70TH St
West Allis, WI 53214-3147
Phone (414) 773-6600

Hospital & facility affiliations

  • Horizon Homecare and Hospice Hospice, Milwaukee, WI, CCN 521531
  • Ascension Columbia St Marys Hospital Milwaukee Hospital, Milwaukee, WI, CCN 520051
  • Ascension SE Wisconsin Hospital Hospital, Milwaukee, WI, CCN 520136
  • Ascension Sacred Heart Rehabilitation Hospital Inpatient rehabilitation facility, Mequon, WI, CCN 523025

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Calumet Hospital, Inc CurrentSince Feb 25, 2025 Accepting new patients
Columbia St. Mary'S Hospital Milwaukee Inc CurrentSince Nov 8, 2020 Accepting new patients
Columbia St. Mary'S Hospital Milwaukee, Inc Current Accepting new patients
Ascension Medical Group-Southeast Wisconsin Inc CurrentSince May 22, 2020 Accepting new patients
Columbia St. Mary'S Hospital Milwaukee, Inc CurrentSince Nov 8, 2020 Accepting new patients

Locations

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

614 Memorial Dr
Chilton, WI 53014
Phone (800) 458-4042

400 W River Woods Pkwy
Glendale, WI 53212
Phone (414) 465-3000

2323 N Lake Dr
Milwaukee, WI 53211
Phone (414) 291-1000

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

Organizations & group practices 8

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.

Hospital & facility affiliations 5

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": "1500854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502755200000",
    "number": "1194248914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT OF GME, 4646 N MARINE DR",
            "address_2": "7TH FL STE 7100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 N MARINE DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405759",
            "telephone_number": "773-564-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAJI",
        "first_name": "MOHAMED",
        "middle_name": "IHTESHAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-24",
        "last_updated": "2017-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RA0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": "IL",
            "license": "125.069826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.