NPIMap

Individual provider Active NPI

Jay Shah, MD

  • Diagnostic Radiology Physician
  • Dunlap, IL
National Provider Identifier
1346656873
Registry record updated Jul 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
70616-20 Issued in WI
Practice address
11327 N Daisy Rd
Dunlap, IL 61525-9436
Phone
(307) 277-2487
NPI assigned
Jul 4, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 70616-20 WI Primary

Addresses

Primary practice location

11327 N Daisy Rd
Dunlap, IL 61525-9436

Mailing address

11327 N Daisy Rd
Dunlap, IL 61525-9436

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, OH2 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
I20200603000288 IN Practitioner - Diagnostic Radiology 4284946260 Reassigns benefits to 2 organizations
I20200618000991 OH Practitioner - Diagnostic Radiology 4284946260 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Michigan State University College of Human Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fort Wayne Radiology Associates LLCGroup PAC ID 5294624060, 35 clinicians
P.E.T. Imaging Services, LLCGroup PAC ID 2668412842, 8 clinicians

Practice addresses (Care Compare)

1035 W Wayne St
Paulding, OH 45879-1544
Phone (419) 399-4080

3707 New Vision Dr
Fort Wayne, IN 46845-1702
Phone (260) 469-4738

Hospital & facility affiliations

  • Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021
  • Parkview Whitley Hospital Hospital, Columbia City, IN, CCN 150101
  • Parkview Wabash Hospital, Inc Hospital, Wabash, IN, CCN 151310
  • Parkview Dekalb Hospital Hospital, Auburn, IN, CCN 150045
  • Community Hospitals and Wellness Centers Hospital, Bryan, OH, CCN 360121

Merit-based Incentive Payment System (MIPS)

Final score
80.28 of 100Reported as group
Quality
77.29
Improvement activities
40
Cost
73.88

Merit-based Incentive Payment System (MIPS)

Final score
85.81 of 100Reported as group
Quality
80.59
Promoting interoperability
100
Improvement activities
40
Cost
72.11

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Hospitals and Wellness Centers CurrentSince Mar 16, 2021 Accepting new patients
Fort Wayne Radiology Associates LLC Diagnostic Radiology CurrentSince Jul 1, 2020 Accepting new patients
P.E.T. Imaging Services, LLC Diagnostic Radiology CurrentSince Jul 1, 2020 Accepting new patients
Community Hospitals and Wellness Centers CurrentSince Mar 16, 2021 Accepting new patients
Breast Diagnostic Center, LLC Diagnostic Radiology Past Accepting new patients

Locations

3707 New Vision Dr
Fort Wayne, IN 46845
Phone (260) 373-4000

121 Westfield Dr
Archbold, OH 43502
Phone (419) 445-2015

433 W High St
Bryan, OH 43506
Phone (419) 636-1131

1035 W Wayne St
Paulding, OH 45879
Phone (419) 399-4080

Interoperability endpoints

  • Direct secure messaging: jshah237854@direct.parkviewexchange.com

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1404432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594944000000",
    "number": "1346656873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11327 N DAISY RD",
            "city": "DUNLAP",
            "state": "IL",
            "postal_code": "615259436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11327 N DAISY RD",
            "city": "DUNLAP",
            "state": "IL",
            "postal_code": "615259436",
            "telephone_number": "307-277-2487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "JAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-04",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "70616-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dunlap, IL

Sources for this page

Verify at the official NPI Registry.