Individual provider Active NPI

Imtiazuddin Shaik, MD

  • Surgery Physician
  • Orlando, FL
National Provider Identifier
1194981498
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
ME126757 Issued in FL
Practice address
9430 Turkey Lake Rd Ste 114
Orlando, FL 32819-8015
Phone
(407) 354-1202
Fax
(407) 351-8801
NPI assigned
Aug 6, 2008
Last updated
Apr 25, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 57014187 OH
Transplant Surgery Physician 204F00000X A121450 CA
Transplant Surgery Physician 204F00000X ME126757 FL
Transplant Surgery Physician 204F00000X 275722 NY
Surgery Physician 208600000X ME126757 FL Primary

Addresses

Primary practice location

9430 Turkey Lake Rd Ste 114
Orlando, FL 32819-8015

Mailing address

9430 Turkey Lake Rd Ste 114
Orlando, FL 32819-8015
Phone (407) 354-1202

Other identifiers 2

IdentifierTypeStateIssuer
018738400MedicaidFL
1194981498MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, TX, OK3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20160725002763 FL Practitioner - General Surgery 3072777127 Reassigns benefits to 1 organization
I20221122001543 TX Practitioner - General Surgery 3072777127 Reassigns benefits to 1 organization
I20231025000548 OK Practitioner - General Surgery 3072777127 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acute Care Surgical Affiliates of Texas PAGroup PAC ID 9931446481, 44 clinicians
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

2001 N Oregon St
El Paso, TX 79902-3320
Phone (915) 320-3393

9430 Turkey Lake Rd
Suite 114
Orlando, FL 32819-8015
Phone (407) 354-1202

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.91 of 100Reported as group
Quality
61.18
Promoting interoperability
100
Improvement activities
40
Cost
71.86

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
57014187OHMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health Medical Group Inc CurrentSince Apr 17, 2023 Accepting new patients
Acute Care Surgical Affiliates of Texas PA Surgery CurrentSince Aug 1, 2024 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Apr 17, 2023 Accepting new patients
Acute Care Surgery of South Dakota PC CurrentSince Sep 11, 2023 Accepting new patients
Tenet Hospitals Limited Past Accepting new patients

Locations

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

9430 Turkey Lake Rd
Ste 114
Orlando, FL 32819
Phone (407) 354-1202

110 NW 31st St
Fl 3
Lawton, OK 73505
Phone (580) 250-5200

3401 W Gore Blvd
Lawton, OK 73505
Phone (580) 483-5207

600 Elizabeth St
Corpus Christi, TX 78404
Phone (361) 325-2511

2001 N Oregon St
El Paso, TX 79902
Phone (915) 577-6011

2101 N Oregon St
El Paso, TX 79902
Phone (915) 577-6011

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1217980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682380800000",
    "number": "1194981498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9430 TURKEY LAKE RD STE 114",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328198015",
            "telephone_number": "407-354-1202",
            "fax_number": "407-351-8801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9430 TURKEY LAKE RD STE 114",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328198015",
            "telephone_number": "407-354-1202",
            "fax_number": "407-351-8801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAIK",
        "first_name": "IMTIAZUDDIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-06",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": "57014187",
            "primary": false
        },
        {
            "code": "204F00000X",
            "taxonomy_group": "",
            "desc": "Transplant Surgery",
            "state": "CA",
            "license": "A121450",
            "primary": false
        },
        {
            "code": "204F00000X",
            "taxonomy_group": "",
            "desc": "Transplant Surgery",
            "state": "FL",
            "license": "ME126757",
            "primary": false
        },
        {
            "code": "204F00000X",
            "taxonomy_group": "",
            "desc": "Transplant Surgery",
            "state": "NY",
            "license": "275722",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME126757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018738400",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194981498",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.