NPIMap

Individual provider Active NPI

Nidal Shawahin, MD

  • Internal Medicine Physician
  • Belleville, IL
National Provider Identifier
1245236884
Registry record updated Feb 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036087648 Issued in IL
Practice address
4600 Memorial Dr
Ste. 360
Belleville, IL 62226-5368
Phone
(618) 222-7280
Fax
(618) 222-7281
NPI assigned
Jun 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036087648 IL Primary

Addresses

Primary practice location

4600 Memorial Dr
Ste. 360
Belleville, IL 62226-5368

Mailing address

4600 Memorial Dr
Ste. 360
Belleville, IL 62226-5368
Phone (618) 222-7280

Other identifiers 1

IdentifierTypeStateIssuer
036087648MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20040610000436 IL Practitioner - Internal Medicine 0244213379 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Practice addresses (Care Compare)

1 Memorial Dr
Alton, IL 62002-6722
Phone (618) 463-7240

4600 Memorial Dr
Belleville, IL 62226-5366

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036087648ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Heights Medical Group SC CurrentSince Dec 24, 2017 Accepting new patients
Fairview Heights Medical Group SC CurrentSince Dec 24, 2017 Accepting new patients
PC Associates, LLC Past Accepting new patients
Healthcare Physicians of Southern Illinois, PC Internal Medicine Past Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

4600 Memorial Dr
Ste 100
Belleville, IL 62226
Phone (618) 222-0000

4600 Memorial Dr
Belleville, IL 62226
Phone (314) 283-7458

4600 Memorial Dr
Ste 360
Belleville, IL 62226
Phone (618) 222-7280

4600 Memorial Dr
Ste 20
Belleville, IL 62226
Phone (618) 233-5000

4500 Memorial Dr
Swansea, IL 62226
Phone (618) 233-7750

660 Mason Ridge Center Dr
Saint Louis, MO 63141
Phone (314) 273-6433

Interoperability endpoints

  • Direct secure messaging: nshawahin166319@direct.carenet.org

Organizations & group practices 4

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 10

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": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613088000000",
    "number": "1245236884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 MEMORIAL DR",
            "address_2": "STE. 360",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265368",
            "telephone_number": "618-222-7280",
            "fax_number": "618-222-7281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 MEMORIAL DR",
            "address_2": "STE. 360",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265368",
            "telephone_number": "618-222-7280",
            "fax_number": "618-222-7281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAWAHIN",
        "first_name": "NIDAL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-27",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036087648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036087648",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4600 Memorial Dr",
            "address_2": "Ste. 360",
            "city": "Belleville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622265368",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

Verify at the official NPI Registry.