NPIMap

Organization Active NPI

Darshan J Shah MD LLC

  • Internal Medicine Physician
  • Enfield, CT
National Provider Identifier
1366776775
Registry record updated Oct 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
038479 Issued in CT
Legal business name
DARSHAN J SHAH MD LLC
Practice address
139 Hazard Ave BLDG 4
Enfield, CT 06082-4583
Phone
(860) 763-0208
NPI assigned
Oct 1, 2009
Last updated
Oct 1, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2009

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

Authorized official

Name
Dr. Darshan J Shah, MDNPI 1558355750
Title
Member
Phone
(860) 763-0208

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 038479 CT Primary

Addresses

Primary practice location

139 Hazard Ave BLDG 4
Enfield, CT 06082-4583

Mailing address

47 E Main St
Stafford Springs, CT 06076-1227
Phone (860) 684-5871

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091217000470 CT Part B Supplier - Clinic/Group Practice 0547300857 Receives reassigned benefits from 3 practitioners
Practice locations: Enfield, CT

National Provider Directory

National Provider Directory

Locations

139 Hazard Ave
#4
Enfield, CT 06082
Phone (860) 763-0208

139 Hazard Ave
Bldg 4-14
Enfield, CT 06082

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1254355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254355200000",
    "number": "1366776775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 E MAIN ST",
            "city": "STAFFORD SPRINGS",
            "state": "CT",
            "postal_code": "060761227",
            "telephone_number": "860-684-5871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 HAZARD AVE BLDG 4",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060824583",
            "telephone_number": "860-763-0208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DARSHAN J SHAH MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-01",
        "last_updated": "2009-10-01",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "DARSHAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "860-763-0208",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "038479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Enfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.