MD Shahaduzzaman, NURSE PRACTITIONER

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

AP135140 Issued in TX

Practice address

7812 Gateway Blvd. East, Suite 110
El Paso, TX 79915

Phone

(915) 533-2888

NPI assigned

Sep 27, 2017

Last updated

Dec 24, 2022By 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

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Select Outpatient Services IncGroup PAC ID 4082868815, 750 clinicians

Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Kadlec Regional Medical CenterGroup PAC ID 9739098617, 402 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tri-Cities Home Health Home health agency, Kennewick, WA, CCN 507010
• Columbia River Home Health Home health agency, Kennewick, WA, CCN 507061
• Kadlec Regional Medical Center Hospital, Richland, WA, CCN 500058

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Kadlec Regional Medical Center

  • General Acute Care Hospital
  • Richland, WA
  • NPI 1972507580
  Medicare reassignment Care Compare group NPD
• Healthsquare PLLC

  dba HealthSquare Adult Care

  • Health Service Clinic/Center
  • West Richland, WA
  • NPI 1144933722
  NPD Authorized official
• Select Rehabilitation, LLC

  • Rehabilitation Clinic/Center
  • Glenview, IL
  • NPI 1346368248
  Care Compare group
• Kadlec Regional Medical Center

  • Orthopaedic Surgery Physician
  • Richland, WA
  • NPI 1194263608
  NPD
• Kadlec Regional Medical Center

  dba Kadlec Regional Medical Center - Rehab Unit

  • Rehabilitation Hospital Unit
  • Richland, WA
  • NPI 1790319580
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Iron Bridge Healthcare, Inc.

  dba Columbia River Home Health

  • Home Health Agency
  • Kennewick, WA
  • NPI 1699263079
  Care Compare affiliation
• Kadlec Regional Medical Center

  • General Acute Care Hospital
  • Richland, WA
  • NPI 1972507580
  Care Compare affiliation
• Tri-Cities Home Health, LLC

  dba Tri Cities Home Health

  • Home Health Agency
  • Kennewick, WA
  • NPI 1679547244
  Care Compare affiliation

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

{
    "created_epoch": "1506470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671840000000",
    "number": "1356850861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7812 GATEWAY BLVD. E. SUITE 110",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "79915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7812 GATEWAY BLVD. EAST, SUITE 110",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "79915",
            "telephone_number": "915-533-2888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAHADUZZAMAN",
        "first_name": "MD",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-27",
        "last_updated": "2022-12-24",
        "certification_date": "2022-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "AP135140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mshahaduzzaman1109518@wm.providencedirect.org",
            "affiliation": "N",
            "address_1": "1508 W 7th Ave",
            "city": "Kennewick",
            "state": "WA",
            "country_code": "US",
            "postal_code": "993365260",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mshahaduzzaman1109518@wm.providencedirect.org",
            "affiliation": "N",
            "address_1": "560 Gage Blvd Ste 102",
            "city": "Richland",
            "state": "WA",
            "country_code": "US",
            "postal_code": "993529531",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jirga Shah, DDS
• Joel Shah, DO, MPH
• Benjamin Shahabi-Azad, MD
• Mariam Shahabi
• Amena Shahabuddin, PA-C
• Haroutioun S Shahinian, M.D.
• Mark Shahinian, MEDICAL STUDENT
• Sanna Shakeebai
• Paul Joseph Shamburger
• Waseem Shami, M.D.

• Gerontology Nurse Practitioner in El Paso, TX
• Providers in El Paso, TX by specialty
• Gerontology Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.