NPIMap

Individual provider Active NPI

Mita Manhar Shah, M.D.

  • Nephrology Physician
  • San Diego, CA
National Provider Identifier
1194773010
Registry record updated Aug 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A71739 Issued in CA
Practice address
200 W Arbor Dr
San Diego, CA 92103-9000
Phone
(800) 926-8273
NPI assigned
May 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A71739 CA Primary

Addresses

Primary practice location

200 W Arbor Dr
San Diego, CA 92103-9000

Mailing address

PO Box 232410
San Diego, CA 92193-2410

Other identifiers 1

IdentifierTypeStateIssuer
00A717390MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20050602001103 CA Practitioner - NephrologyPractitioner - Internal Medicine 4587607320 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
University of Florida College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Regents of the University of CaliforniaGroup PAC ID 3577476761, shared by 18 NPIs, 2,047 clinicians

Practice addresses (Care Compare)

200 W Arbor Dr
San Diego, CA 92103-9000
Phone (858) 657-7000

Hospital & facility affiliations

  • UC San Diego Health Hillcrest - Hillcrest Med Ctr Hospital, San Diego, CA, CCN 050025
  • Uci Health-Orange Hospital, Orange, CA, CCN 050348

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California Nephrology CurrentSince Dec 1, 2004 Accepting new patients
Regents of the University of California - Ucsd Medical Group CurrentSince Feb 12, 2013 Accepting new patients
Regents of the University of California Current Accepting new patients
Regents of the University of California CurrentSince Dec 1, 2004 Accepting new patients
Regents of the University of California Current Accepting new patients
Regents of the University of California Past Accepting new patients
Regents of the University of California Ucsd Head and Neck Surgery Past Accepting new patients
Jacobson Memorial Hospital Care Center Past Accepting new patients
Regents of the University of California Nephrology Past Accepting new patients

Locations

9400 Campus Point Dr
La Jolla, CA 92093
Phone (858) 249-3800

35900 Bob Hope Dr
Ste 257
Rancho Mirage, CA 92270
Phone (760) 321-2500

4510 Executive Dr
Ste 7
San Diego, CA 92121

4168 Front St
Fl 3
San Diego, CA 92103
Phone (619) 543-3995

4510 Executive Dr
Ste 201
San Diego, CA 92121
Phone (858) 457-7994

4168 Front St
San Diego, CA 92103
Phone (619) 471-0420

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

Organizations & group practices 9

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 3

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": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565740800000",
    "number": "1194773010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 232410",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921932410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W ARBOR DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921039000",
            "telephone_number": "800-926-8273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "MITA",
        "middle_name": "MANHAR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2019-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A71739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A717390",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.