Kevin L Shady, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

036088119 Issued in IL

Practice address

915 N Grand Blvd
Saint Louis, MO 63106-1621

Phone

(314) 652-4100

NPI assigned

Nov 1, 2006

Last updated

Mar 12, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 15

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1245317304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 N GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631061621",
            "telephone_number": "314-652-4100",
            "fax_number": "314-548-4748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 N GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631061621",
            "telephone_number": "314-652-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADY",
        "first_name": "KEVIN",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036088119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR CARE",
            "identifier": "300066968",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR CARE",
            "identifier": "300066973",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE",
            "identifier": "1390",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208893503",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HLT PART",
            "identifier": "398004",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HCARE USA",
            "identifier": "46068",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360881191",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP",
            "identifier": "2781",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATE WAY",
            "identifier": "F70866",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCY",
            "identifier": "431725842MID",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE",
            "identifier": "0006021895",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUER CHOICE",
            "identifier": "18177",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PH PLAN",
            "identifier": "1609006",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "H LINK",
            "identifier": "251709",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR CARE",
            "identifier": "300066978",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brooke Noelle Shadel, MD, PHD, MPH
• Ghazal Shadmani, MD
• Michael Stuart Shadwell
• Charese Shadwick, PHARMD, BCPP
• Kristine Shady Lewis, MD
• Hannah Christine Shaffer
• Jason P. Shaffer, CRNA
• Jenny Lynne Shaffer, M.D.
• Joan Shaffer, M.D.
• Molly Lee Shaffer, ME.D

• Diagnostic Radiology Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Diagnostic Radiology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.