Jagdish Vallabhdas Shah, M.D.
Individual provider Active NPI Psychiatry Physician · Rock Hill, SC
NPI 1356301360 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1356301360
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 17315 (SC)
- Practice address
- 205 Piedmont Blvd
Rock Hill, SC 29732-1836 - Phone
- (704) 842-6467
- Fax
- (704) 854-4235
- NPI assigned
- Mar 24, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 18
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- Other, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- South Carolina Dept of Mental Health Accounting Office
Practice addresses (Care Compare)
448 Lakeshore Pkwy
Suite 110
Rock Hill, SC 29730-4264
Phone (803) 329-3177
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120202000414 | SC | Practitioner - Psychiatry | 2668421025 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17315 | SC | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Carolina Dept of Mental Health Accounting Office | Current |
Accepting new patients | |
| South Carolina Dept of Mental Health Accounting Office | Current |
Accepting new patients | |
| South Carolina Dept of Mental Health Accounting Office | Current | Accepting new patients | |
| Amisub of South Carolina, Inc. | Past | Accepting new patients | |
| South Carolina Dept of Mental Health Accounting Office | Past |
Accepting new patients | |
| South Carolina Dept of Mental Health Accounting Office | Past | Accepting new patients | |
| Carolina Center for Counseling & Clinical Services, Inc. | Past | Accepting new patients | |
| Amisub of South Carolina, Inc. | Past | Accepting new patients |
Locations
200 McGee Rd
Anderson, SC 29625
Phone (864) 260-2220
817 Brown St
Bishopville, SC 29010
Phone (803) 484-9414
524 Doctors Ct
Chester, SC 29706
Phone (803) 325-7744
2414 Bull St
Columbia, SC 29201
Phone (803) 898-2461
1800 Colonial Dr
Columbia, SC 29203
Phone (803) 898-0123
205 Piedmont Blvd
Rock Hill, SC 29732
Phone (803) 325-4848
448 Lakeshore Pkwy
Ste 110
Rock Hill, SC 29730
Phone (803) 323-1779
115 Carter Park Dr
Seneca, SC 29678
Phone (864) 885-0157
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 17315 | SC | Yes |
Addresses
Primary practice location
205 Piedmont Blvd
Rock Hill, SC 29732-1836
Mailing address
9715 Baileywick Rd
Charlotte, NC 28277-2485
Phone (704) 277-2663
Other providers in Rock Hill, SC
- Michelle Annette Settle
- David L Seward
- Sheldon Spencer Sewell
- Birju Dipak Shah
- Gaurang C Shah
- Jugalkishor Keshavla Shah
- Nemish Shah
- Tejaskumar M Shah
- Takenya Shannon
- Tatanasika Lavonne Shannon
All providers in Rock Hill, SC · Psychiatry Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.