NPIMap

Individual provider Active NPI

Shivaprasad K Shetty, M.D.

  • Family Medicine Physician
  • Morenci, MI
National Provider Identifier
1235133190
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301062948 Issued in MI
Practice address
240 W Main St
Morenci, MI 49256-1455
Phone
(517) 458-6848
Fax
(517) 458-7614
NPI assigned
Jun 9, 2005
Reactivated
Mar 21, 2006
Last updated
Nov 3, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35068087S OH
Family Medicine Physician 207Q00000X 4301062948 MI Primary

Addresses

Primary practice location

240 W Main St
Morenci, MI 49256-1455

Mailing address

240 W Main St
Morenci, MI 49256-1455
Phone (517) 458-6848

Other identifiers 2

IdentifierTypeStateIssuer
3459792MedicaidMI
0152338MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sshetty13839@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, MI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040123000793 OH Practitioner - Family Practice 5991607863 Reassigns benefits to 5 organizations
I20040301001237 MI Practitioner - Family Practice 5991607863 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Medical Partners Northern Region LLCGroup PAC ID 0244407823, 21 clinicians
RS Medical Group PCGroup PAC ID 3375501240, 5 clinicians

Practice addresses (Care Compare)

137 S Fulton St
Wauseon, OH 43567-1351
Phone (419) 335-2811

1400 E 2ND St
Defiance, OH 43512-2440
Phone (419) 784-1414

3355 Briarfield Blvd E
Maumee, OH 43537-8668
Phone (419) 868-3788

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301062948MIMDFamily Medicine Physician
35068087SOHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Medical Partners Northern Region Specialty Care LLC CurrentSince Jun 29, 2022 Accepting new patients
Mercy Medical Partners Northern Region Specialty Care LLC CurrentSince Jun 29, 2022 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Bixby Hospital Past Accepting new patients
FCHC Medical Care, LLC Past Accepting new patients
Mercy Health - Defiance Hospital LLC Past Accepting new patients
Emma L. Bixby Medical Center Past Accepting new patients

Locations

1400 E 2nd St
Defiance, OH 43512
Phone (419) 784-1414

1426 Scott St
Napoleon, OH 43545
Phone (419) 599-5600

1600 E Riverview Ave
Ste 101
Napoleon, OH 43545
Phone (419) 592-8774

725 S Shoop Ave
Wauseon, OH 43567
Phone (419) 335-2015

Organizations & group practices 12

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 8

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": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1235133190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 W MAIN ST",
            "city": "MORENCI",
            "state": "MI",
            "postal_code": "492561455",
            "telephone_number": "517-458-6848",
            "fax_number": "517-458-7614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 W MAIN ST",
            "city": "MORENCI",
            "state": "MI",
            "postal_code": "492561455",
            "telephone_number": "517-458-6848",
            "fax_number": "517-458-7614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHETTY",
        "first_name": "SHIVAPRASAD",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2023-11-03",
        "deactivation_date": "2006-03-15",
        "reactivation_date": "2006-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35068087S",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301062948",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3459792",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0152338",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sshetty13839@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Morenci, MI

Sources for this page

Verify at the official NPI Registry.