Shital Tapan Mehta, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

036108277 Issued in IL

Practice address

275 E Court St
Suite 102
Kankakee, IL 60901-3838

Phone

(815) 939-3544

Fax

(815) 939-3557

NPI assigned

Apr 23, 2007

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Psychiatry

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prime Healthcare Illinois Medical Group LLCGroup PAC ID 5597275685, 278 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Presence St Marys Hospital Hospital, Kankakee, IL, CCN 140155
• Riverside Medical Center Hospital, Kankakee, IL, CCN 140186

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Prime Healthcare Illinois Medical Group LLC

  • Multi-Specialty Clinic/Center
  • Des Plaines, IL
  • NPI 1023837689
  Medicare reassignment Care Compare group NPD
• Tca Health Inc NFP

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1184757353
  Medicare reassignment NPD
• Tca Health Inc NFP

  • Federally Qualified Health Center (FQHC)
  • Hammond, IN
  • NPI 1093404576
  NPD
• The Helen Wheeler Center for Community Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Kankakee, IL
  • NPI 1912053950

  Psychiatry

  NPD (past)

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

• Riverside Medical Center

  • General Acute Care Hospital
  • Kankakee, IL
  • NPI 1538208210
  Care Compare affiliation
• St Marys Hospital - Kankakee LLC

  • General Acute Care Hospital
  • Kankakee, IL
  • NPI 1467290809
  Care Compare affiliation

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1205054608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3195 WOODHAVEN DR",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609144902",
            "telephone_number": "815-935-1634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 E COURT ST",
            "address_2": "SUITE 102",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013838",
            "telephone_number": "815-939-3544",
            "fax_number": "815-939-3557"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21 Heritage Dr Ste 102",
            "address_purpose": "LOCATION",
            "city": "Bourbonnais",
            "state": "IL",
            "postal_code": "609141465",
            "country_code": "US",
            "telephone_number": "815-837-8204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEHTA",
        "first_name": "SHITAL",
        "middle_name": "TAPAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-23",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036108277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smehta46428@ce-direct.presencehealth.org",
            "affiliation": "N",
            "address_1": "21 Heritage Dr Ste 102",
            "city": "Bourbonnais",
            "state": "IL",
            "country_code": "US",
            "postal_code": "609141465",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Med Peds Associates
• Med-Peds Associates,P.C.
• Medcentre Pharmacy
• Medical Associates of Kankakee PC
• Mediexperts, LLC
• Ryan J Meiners, MD
• Joseph A Meisenbach, MD
• Timothy J Menard, PA
• Jeffery P Mendell, MD
• Mercy Medical & Weight Loss Center, Inc.

• Psychiatry Physician in Kankakee, IL
• Providers in Kankakee, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; 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.